Evaluating Coding Patterns

Kick-start your compliance plan and risk management efforts by evaluating coding patterns and documentation.

1. Generate a CPT frequency report for all evaluation and management (E&M) codes, for each individual physician in the practice. This report shows the volume of each code that each physician selected. Select a date range of one year for this report data.

2. Enter the CPT frequency for each series of codes into an Excel spreadsheet and create individual bar graphs for each physician. Reviewing a bar graph is much easier than reading columns of numbers.

3. Review and discuss each physician's coding patterns. Unless you have a variety of subspecialties in the practice, the patterns should be fairly similar. If they aren't, it's time to investigate.

4. Add the Medicare data (both national and state) to your Excel spreadsheet. Determine whether physician coding patterns are similar to other specialists in your state, and nationally. Medicare assumes that orthopaedists in Texas, for example, have similar coding patterns, and expect that these patterns probably vary from orthopaedists in Arizona.

5. Randomly pull at least ten charts for each physician and analyze whether the documentation matches the code selected. All practices should do this quarterly, but it's especially important if your physicians' patterns do not match those in their specialty or state, or if they use a significant portion of high level codes.

6. Discuss the results of the documentation audit and the results of the comparison against national and state data. Determine the practice's level of risk and discuss coding education and training programs for the physicians. Designate one physician as "Doctor Coding." This physician should be the champion for proper and ethical coding in the group, and counsel those physicians who need to improve their coding habits.

If Your Internal Audit Indicates a Need for Training...KZA Can Help!

Our coding instructors can perform on-site coding training, as well as assist with a variety of coding and documentation services, including hourly coding consultations. To learn more:

On-Site Coding and Documentation Training

Coding and Documentation Review