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?