CODING: Don't Let the Bell Curve Fool You

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Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This article explains how auditors and practice leaders can review evaluation and management coding patterns and supporting documentation to look for unusual trends that may suggest coding issues. It is aimed at physicians, coders, and compliance staff who want a general overview of audit approaches, chart review, and year-over-year pattern analysis. The discussion stays at a high level and focuses on why these reviews matter for compliance and documentation oversight.

Why This Topic Matters

Coding pattern reviews can help practices understand whether their billing and documentation habits are consistent, supported, and worth a closer internal audit. The article is relevant for compliance monitoring and for practices seeking to compare physician-level reporting patterns over time.

Article Sections

  1. Audit review and documentation matching

    Introduces a chart review approach that compares submitted professional services coding with the documentation retained in the medical record. The section frames this as part of general compliance monitoring.

  2. Evaluating physician coding patterns

    Describes using physician-level reporting patterns to spot unusual distribution trends in evaluation and management activity. The section discusses how outlier patterns can prompt closer review.

  3. Looking for changes over time

    Explains a year-over-year comparison approach to see whether a physician’s reporting pattern has shifted. The section focuses on trend analysis as another way to assess consistency.

What You Will Learn

  • How chart audits can be used as part of compliance review
  • How to compare submitted services with supporting documentation
  • How physician-level reporting patterns can be reviewed for unusual trends
  • How year-to-year comparisons can help identify changes in coding behavior

Who Should Read This

  • Physicians
  • Professional coders
  • Compliance staff
  • Practice managers
  • Internal auditors

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