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Hospital
Outpatient Surgery CPT Audits
These
audits assess the accuracy of CPT codes assigned to outpatient surgical
procedures, including interventional radiology as desired. ICD-9-CM
diagnosis codes are also reviewed to ensure linkage to the procedures.
All coding changes suggested are supported by specific references
in the medical record and citations from reliable, definitive sources
for coding guidelines. Audits can be scheduled on a regular, recurring
basis or as a one time review.
As
with DRG audits, the same three components comprise the surgery
audit process:
Sample
Selection : The
same rules on sample selection apply for hospital surgery audits
as well. Case selection criteria can vary based on the needs of
the hospital. Random audits measure the overall performance while
targeted audits instead focus on particular areas of concern.
Case
Review : Because
the objective is to assess the accuracy of outpatient surgery coding,
the auditor will review the CPT codes assigned to all surgical procedures
and identify those discrepancies that affect APC assignment or form
a pattern of miscoding. The audit will also verify the ICD-9-CM
diagnosis codes and will note any significant discrepancies as well.
Finalization
: The
final report comprises a summary of the findings. The summary also
notes any coding trends or other issues the attachment lists each
case and the impact on APC assignment and payment.
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