As reported in the April 2011 AAP Pediatric Coding Newsletter™, the Office of Inspector General (OIG) 2011 work plan includes a review of Medicare claims to identify trends in evaluation and management (E/M) coding and Medicare payments of E/M services to identify electronic health record (EHR) documentation practices that result in identical documentation and possible improper payments. In addition to those focused reviews, the work plan is also reviewing the appropriate reporting of modifiers and diagnosis codes and compliance with Medicare incident-to guidelines.

Because most commercial payers pay close attention to the focus reviews of the OIG, your practice should be performing routine medical record documentation and coding audits to be sure that all services performed are supported and appropriately documented before they are submitted for payment.

You are checking that your practice is compliant and adhering to medical record standards; appropriately reporting Current Procedural Terminology (CPT®),...

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