| |
Please review our surgical coding compliance example and let us know if you have any questions. |
| 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
|
|
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:
|
|
|
