Make sure you are addressing these top documentation and coding compliance concerns.
- Risk-based review of evaluation and management codes (E/M):
- Appropriate application of FY21 E/M code guideline changes
- Telehealth visits (audio and visual vs. telephone only); Medicaid behavioral health telehealth
- Review providers with higher than 10% of visits in level 4 and 5, or outliers on E/M bell curve
- Level 4 and 5 visits with only one diagnosis code
- Conduct highly productive provider analysis (review visits per day outlier)
- Appropriate use of prolonged and critical care services codes as well as time-based codes
- Appropriate use of Modifiers
- High risk modifiers: 25, 57, 59 (including XE, XP, XS, XU)
- Other modifiers to focus on: 24, 58, 62, 63, 76, 78, 80, AS
- Incident to services (appropriate reporting of NPP services and split-shared services)
- Teaching physician and supervising physician services
- Coding and reporting co-morbidities for coverage of routine foot care (meeting specificity in the LCD, use of modifiers Q7, Q8, Q9)
- Wound care (especially debridement services 1104x, 97597)
- Copy/Paste documentation (ensure documentation is unique for the visit and presenting complaints)
- Chart review for documentation of active treatment and specificity of chronic conditions to support HCCs
- Advanced Care Planning Services – ensure appropriate clinical documentation to support face to face services and/or time spent discussing ACP services
- Data mining to identify trends/outliers (e.g. conduct top billed procedure analysis, identify and follow up on trends in claim denials)
- UASI Compliance Analysis
- Comparing Codes Across ICD Versions: Spinal stenosis
- Top 10 Documentation and Coding Issues for Physician Practices in 2021
- Top 10 Documentation and Coding Issues for Hospitals in 2021
- 2021 Documentation and Coding Compliance Tips
- UASI Compliance Work Plan Analysis – Inpatient Documentation and Coding Issues