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Doody's Review ServiceReviewer: LouAnn Schraffenberger, MBA, RHIA, CCS, CCS-P(Advocate Health Care)
Description: This is a guide on how to conduct an audit of CPT evaluation and management (E&M) code usage. E&M codes are used by physicians and other healthcare providers to describe and bill to health insurance companies the healthcare services they provide to their patients such as office visits, hospital visits, consultations, and other non-procedural services.
Purpose: The purpose is to provide readers with a step-by-step guide to conduct an E&M code audit. The book describes how to select an E&M code, how to conduct the entire audit and how to report the audit findings. The goal is to assure acute data capture and maximum reimbursement for the healthcare provider.
Audience: Individuals who would be interested in the subject are physician coders, office managers, compliance officers, physicians, and others involved in the business management of a physician office or medical group practice. The two authors are certified coders with experience in physician practice coding management and compliance audits.
Features: Chapter 1 provides the reader with a step-by-step approach to choosing an E&M code. Chapter 2 outlines how to perform a risk assessment to take inventory of risk areas and identify risks in terms of code selection. Chapter 3 describes how to structure an audit, including the sample size, establishing a baseline, tracking results, and determining the audit cycle. Chapter 4 details the audit process using an audit tool and a case-study scenario. Chapter 5 explains how to draft an audit summary, revenue reports, and an action plan. Chapter 6 identifies how to implement a coding compliance plan. Accompanying the book is a CD-ROM that contains several audit forms, references for auditing, supplemental information, and case study exercises.
Assessment: This is a straightforward, step-by-step guide to assist physician coders or practice managers develop an ongoing E&M coding audit program. The chapters focus on specific steps in the process and provide good advice and suggestions. The CD-ROM contains supplemental chapters with exercises, a variety of guidelines published by reputable sources, and custom forms. By reading the book and completing an evaluation, readers can receive continuing education credit for maintenance of the American Academy of Professional Coders (AAPC) credentials. I find the price a little high for a 110-page book and CD-ROM as it is not a one-of-a-kind reference on the market. The book is quick and easy to read and offers the reader solid, practical advice on conducting important work on behalf of physicians for their accurate reporting of E&M codes for their professional reimbursement.