MCCG240 EVALUATION AND MANAGEMENT SERVICES Coding Audit Email

MCCG240 EVALUATION AND MANAGEMENT SERVICES

Coding Audit Email

Course, Program, and Institutional Outcome(s) Assessed:

This assignment measures your ability to meet the follows outcome(s):

· Course outcome: Evaluate E/M codes assigned to patient encounters in health records for accuracy and make any necessary corrections.

· Program outcome: Abstract information from medical charts to assign the correct diagnosis (ICD-10), procedure (CPT), and supply (HCPCS Level II) codes in a variety or medical situations.

· Relational Learning: Transfer knowledge, skills, and behaviors acquired through formal and informal learning and life experiences to new situations.

Relevant Background Information:

Coders will audit charts already coded to determine the accuracy of the codes assigned.  This is a critical skill that you need to develop to help you understand the complexity of medical coding. 

Assignment Purpose:

This assignment asks you to review real patient medical records and the codes already assigned to these and determine if the assigned codes are correct, following the Official ICD-10 Coding Guidelines and CPT Coding Guidelines.

Assignment Directions:

Imagine that you are a coding supervisor and are worried about a potential OIG audit. Therefore, you decide to review high level E/M code assignments by your staff of three coders. The goal of this review is to ensure the documentation supports the codes assigned by your coding staff.

Follow the steps below to complete this assignment:

1. Review the following cases from your You Code It! textbook. Imagine that these cases were coded by your staff as indicated below.

Coder	Patient Case	Codes Assigned
Angela Johnston	Chapter 13: Maxine Phelps	DX: N63 PX: 99213
	Chapter 15: Peter Groenendal	DX: H05.211, J32.8, E11.9 PX: 99204
	Chapter 20: Kyle Graddy	DX: I82.4Z9 PX: 99204, 93971
Katherine Bell	Chapter 14: Brenda Transil	DX: K68.19, C79.89, Z85.850, Z85.3 PX: 99254
	Chapter 15: Claudia Swanklee	DX: S05.01XA, W60.XXXA PX: 99243
	Chapter 21: Charlotte Goren	DX: G30.9, F02.80 PX: 99204
Alex Spinnell	Chapter 14: Denny Langer	DX: Z51.11, C40.22, C78.0 PX: 99224
	Chapter 17: Rhonda Holmes	DX: J06.9 PX: 99214
	Chapter 22: Marissa Watchorn	DX: T86.812, D47.Z1, A31.9 PX: 99245

2. After thoroughly reviewing each patient case, assign all appropriate ICD, CPT, and/or E/M codes to the patient record. You may choose to use the code books or any encoder to do this.

3. Compare your codes to those assigned by the coders. Determine if the code assignments from the coders are accurate.

4. If the codes are inaccurate, provide rationale to support your code choice.

5. Create a chart or table in Microsoft Word that accomplishes the following:

a. Portrays the code assignments from the coders compared to your code assignments for all patient cases.

b. Provides rationale for any differences between the codes identified by you and the coders.

c. Summarizes the accuracy rate of each coder.

d. If you need help with creating charts and tables in Word, see #9 below.

6. Write an email to your coding staff that explains the following:

a. Summarizes the accuracy rate of your coding staff as a whole department.

b. References the chart you created in Step #5.

c. Describes the potential consequences that could have occurred if you had not found and corrected the errors in their coding.

d. Provides the next steps you will take to ensure their coding is more accurate in the future.

7. Review the attached rubric to determine how your work will be graded.

8. Submit your work by the designated due date. Note that you will submit both the chart and the email, either in one Word document or as two separate documents.

9. Refer to the following resources if you need assistance with creating charts and tables in Word. To view the links below, hold Ctrl while clicking on the link, or copy and paste the link into your web browser.

a. The following video shows how to create a chart in Word: https://www.youtube.com/watch?v=6CJKFE0L1uI

b. The following link contains written directions to add a chart to Word: https://support.office.com/en-us/article/add-a-chart-to-your-document-in-word-ff48e3eb-5e04-4368-a39e-20df7c798932

c. The following link contains both a video and written directions on how to add a table in Word: https://support.office.com/en-us/article/insert-a-table-a138f745-73ef-4879-b99a-2f3d38be612a

MCCG212 Advanced ICD Diagnosis Coding

ICD-10 Patient Coding Scenarios

Rubric

	Level 3	Level 2	Level 1	Level 0
	35-29.75	29.74-24.5	24.49-22.75	22.74-0
Accuracy of code assignments	Student correctly assigned 85-100% (26-30) of the correct codes in all 3 cases	Student correctly assigned 70-84% (21-25) of the correct codes in all 3 cases	Student correctly assigned 65-69% (20) of the correct codes in all 3 cases	Student correctly assigned 64% (19) or less of the correct codes in all 3 cases
	30-25.5	25.4-21	20.9-19.5	19.4-0
Presentation of Data	Student created accurate chart or table with 100% correct accuracy rate percentage. Chart or table presents information very clearly and is very easy to read.	Student created accurate chart or table with the majority of the accuracy rate percentage reported correctly. Chart or table presents information mostly clearly and is mostly easy to read.	Student created accurate chart or table with half of the accuracy rate percentage reported correctly. Chart or table presents information somewhat clearly and is somewhat easy to read.	Student created accurate chart or table with less than half of the accuracy rate percentage reported correctly. Chart or table presents information unclearly and is difficult to read. Or student did not create a chart or table.
	30-25.5	25.4-21	20.9-19.5	19.4-0
Email	Student provides a written email which includes correct and thorough explanations with numerous, specific details to the patient cases. Written email explains all four required bullet points from the directions.	Student provides a written email which includes mostly correct and somewhat thorough explanations with some details to the patient cases. Written email explains three required bullet points from the directions.	Student provides a written email which includes somewhat correct explanations with few details to the patient cases. Written email explains two required bullet points from the directions.	Student provides a written email which includes mostly incorrect explanations with no details to the patient cases. Written email explains one required bullet point from the directions. Or student did not provide a written email.
	5-4.25	4.24-3.50	3.49-3.25	3.24-0
Institutional Outcome	Relational Learning: Work indicates that the student has exceeded expectations for this institutional outcome.	Relational Learning: Work indicates that the student has successfully met expectations for this institutional outcome.	Relational Learning: Work indicates that the student has partially met expectations for this institutional outcome.	Relational Learning: Work indicates that the student has not or scarcely met expectations for this institutional outcome.
	Final Score:	Comments: