Confessions of a Pediatric Management Consultant... Where fame and fortune await those who help keep pediatric practices alive and independent!

Pediatric Chart Accuracy

Written by Chip Hart | Apr 29, 2016 9:09:24 PM

PCC's A1 Coding Resource, Jan, shared with me some interesting data today.  She has kept track of her chart audits dating back to 2008 and wondered what the results looked like.  The E&M results are fascinating.

41% of the charts match her analysis.  The practice said 99213 and the notes supported it.

12% of the time, the notes supported a higher code.  The doctor scratched 99213 on the superbill (or clicked in the EHR) and it could have been a 99214.

Those of you who can do fast math know what's next.

47% of the claims were over-coded.  The doctors said 99214 and the chart note only supports a 99213.  Or 99212.

Our sample size is not large or consistent enough to see if there has been a trend over time.  The data also involves multiple EHRs (almost none PCC's) and a lot of paper charts.  I can't identify any variables that affect the results, I can only say that there aren't just a few bad practices kicking these numbers out of whack.  It's everyone.

When the is last time you had a chart audit?