Surgical Coding Audit Example
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Please review our surgical coding compliance example and let us know if you have any questions.
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| Physician |
Patient |
Original RBRVS Units |
TCN's RBRVS Units |
% Difference |
Unbundled |
Missed Procedure |
Billed but Not Done |
Wrong Code |
Modifier |
Order |
Documentation Deficiency |
Diagnosis |
| Gordon |
1 |
103.30 |
61.30 |
40.7 |
XX |
|
|
|
XX |
|
|
|
| Harvey |
2 |
50.21 |
53.21 |
-5.8 |
|
|
|
X |
X |
|
X |
|
| Harvey |
3 |
34.05 |
17.38 |
49.0 |
|
|
X |
|
|
|
X |
|
| Evans |
4 |
47.10 |
47.10 |
0.0 |
|
|
|
|
X |
|
|
|
| Evans |
5 |
34.05 |
17.38 |
49.0 |
|
|
X |
|
|
|
|
|
| Gordon |
6 |
36.11 |
30.85 |
14.6 |
|
|
|
X |
|
|
|
|
| Smith |
7 |
45.60 |
45.60 |
0.0 |
|
|
|
|
|
|
|
X |
| Smith |
8 |
50.68 |
50.68 |
0.0 |
|
|
|
|
X |
|
|
X |
| Harvey |
9 |
39.12 |
39.12 |
0.0 |
|
|
|
|
|
|
|
|
| Harvey |
10 |
23.36 |
23.36 |
0.0 |
|
|
|
|
|
|
X |
|
| Harvey |
11 |
17.65 |
17.65 |
0.0 |
|
|
|
|
X |
|
X |
|
| Evans |
12 |
12.00 |
12.00 |
0.0 |
|
|
|
|
X |
|
|
X |
| Frank |
13 |
25.47 |
25.47 |
0.0 |
|
|
|
|
X |
|
|
|
| Evans |
14 |
38.55 |
56.77 |
-47.3 |
|
X |
|
|
XX |
|
|
X |
| Evans |
15 |
53.29 |
65.63 |
-23.2 |
|
|
|
XXX |
X |
|
|
|
| Smith |
16 |
72.84 |
50.81 |
30.2 |
|
X |
XX |
|
|
|
|
X |
| Frank |
17 |
16.95 |
16.95 |
0.0 |
|
|
|
|
|
|
|
|
| Smith |
18 |
79.68 |
63.45 |
20.4 |
|
X |
|
XX |
X |
X |
|
X |
| Gordon |
19 |
27.19 |
27.19 |
0.0 |
|
|
|
|
X |
|
|
|
| Frank |
20 |
28.28 |
29.85 |
-5.6 |
|
|
|
X |
|
|
|
X |
| Gordon |
21 |
29.10 |
29.10 |
0.0 |
|
|
|
|
X |
|
|
|
| Frank |
22 |
30.00 |
19.52 |
34.9 |
|
|
|
X |
|
|
|
X |
| Gordon |
23 |
11.42 |
11.42 |
0.0 |
|
|
|
|
X |
|
|
X |
| Evans |
24 |
16.44 |
16.44 |
-30.8 |
|
|
X |
X |
|
|
|
|
| Positive percentage difference means original coding overvalued the case. |
|
| Patient: 1 |
DOS: |
Doctor: Gordon |
|
Original Codes
26485
26412
26140
25240
26055
|
RVU's
28.72
23.94
23.26
16.64
10.74
|
|
Total RVU's 103.30
|
|
|
The Coding
Network's Codes
26412-LT
25320-51
26055-59+FA
|
RVU's
26.94
23.62
10.74
|
Total RVU's 61.30 |
|
Discussion:
- No modifiers were used.
- 26412 includes tendon transfer that was unbundled as 26485.
- 25320 includes synovectomy that was unbundled as 26140 & 25240.
- Finger modifier FA and 59 for separate area were missed.
|
|
Diagnoses:
727.63
727.03
354.0
|
Diagnoses:
727.63
727.03
354.0
|
Discussion:
|
|
| Patient: 2 |
DOS: |
Doctor: White |
|
Original Codes
27826
11044
|
RVU's
44.95
5.29
|
|
Total RVU's 50.21
|
|
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The Coding
Network's Codes
27826
11011-51
|
RVU's
44.95
8.17
|
Total RVU's 53.12 |
|
Discussion:
- Documentation deficiency: Dr. Harvey does not identify which leg.
- Wrong debridement code. Report supports a higher valued open code.
- Modifier needed for multiple procedures.
|
|
Diagnoses:
823.32
E917
|
Diagnoses:
823.32
E917
|
Discussion:
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