Auditing Evaluation and Management Coding: A Step-by-Step Guide to Enhancing Your Practice's Revenue and Compliance Book

About the authors     vii
Introduction     xi
Importance of auditing E/M codes     xi
Common auditing errors: What you may see when auditing your practice     xii
E/M-related resources     xii
E/M guidelines: 1995 vs. 1997     xiv
From an auditor's view: Documentation essentials     xiv
Administrative buy-in     xv
How this book will help you     xvi
How this book is organized     xvi
How to use the CD-ROM     xvii
What's included on your CD-ROM     xviii
Acronyms used in this book     xix
Continuing education instructional guide     xxi
Choosing an E/M code     1
E/M code components     2
Consultations     18
Test your knowledge     21
Performing a risk assessment     23
High-risk areas to monitor     24
Five steps to include     26
Risk data categories     29
Items that can affect risk     30
Test your knowledge     32
E/M audit structure     33
Getting started     33
Choosing an auditor     34
Preaudit preparations     35
Deciding when to audit     38
Establishing a baseline     39
Tracking audit results     42
Auditing teaching physicians     43
Establishing an audit cycle     43
Scoring providers using a matrix     44
Other audit considerations     47
Test your knowledge     49
Using an audit tool     51
Sample medical record documentation     51
History     52
Exam     56
Medical decision-making     60
Final audit results     66
Test your knowledge     67
Packaging your audit     69
Audit reports to include     70
Additional documents to consider     72
Test your knowledge     73
Devising a compliance plan     75
Plan overview     75
Audit policy/procedure     76
New provider orientation     76
Outlier providers     78
Ongoing education     79
Test your knowledge     84
Answers     85
Sample medical record examples     93
New patient office visits (codes 99201-99205)     95
Established patient office visits (codes 99211-99215)     101
Consultation office visits (codes 99241-99245)     105