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Auditor Assessment

Please take this 7-question auditor assessment. Some questions require you to explain your answer. 

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Question 1 of 8

1. Given the following statement in the medical record, would you allow an E&M code to be billed for telehealth? Why or why not? Is this audio/video or audio only? Explain

 

Question 2 of 8

2. What does it mean to an auditor when a provider writes what is highlighted in the below record:

 

A

PCOS is the primary reason for the anovulation.

B

Anovulation should be removed and PCOS should be the primary diagnosis.

C

"Consistent with" removes the ability for the provider to assign PCOS in the office setting because it is non-definitive according to ICD-10 guidelines.

D

"Consistent with" language means the provider should add PCOS as a secondary diagnosis because he/she addressed the condition in the encounter according to ICD-10 guidelines.

Question 3 of 8

3. What is the correct ICD-10 coding sequence given this excerpt from a medical record (consider only the portion provided, understanding that in a typical record, you would review the entire record to establish whether or not something was addressed):

A

N18.30, I10, E87.20, M85.80

B

N18.32, I12.9, E11.65, D89.9

C

I10, N18.32, E11.65

D

I12.9, N18.32, D89.9, E11.65

E

None of the above

Question 4 of 8

If you selected E, explain why. Otherwise, put N/A if you did not. 

Question 5 of 8

4. In reading the below assessement and plan ( this is the only part of the record for review for this question), is this a 99213 or 99214 and explain how you came to that conclusion. 

Question 6 of 8

5. Audit of general medicine record. Reviewing the below documentation, which answer best fits the note:

A

99214; one condition, unclear if stable; provider is changing medication

B

99213; one stable condition per HPI and documented prescription drug management

C

99214; HPI states meds will need to change, and medications are documented as changed to due to ineffectiveness

D

99212; straightforward visit, BP is a common problem and there is very little intervention on behalf of the provider.

Question 7 of 8

6. Urogynecology record. Reviewing this record and the corresponding claim record (what was billed) do you agree or disagree and what codes would you assign for the encounter visit and the diagnosis?

Claim info: 

 

Record documentation: (answer question based on this documentation alone)

 

Select the best answer from below.

 

A

Disagree: assign 99213, 81003, N39.0, M95.2

B

Agree: assign 99214, R39.9 (but add 81003)

C

Disagree: assign 99213, 81003 - QW, R39.9, N95.2

D

Agree with the codes, however, add 81003 and N95.2

Question 8 of 8

7. Using the AMA guidance for 2023 documentation of E&M, which of the following answer(s) is a TRUE statement regarding scoring by medical decision-making:

A

If a provider provides an independent interpretation of a test (not separately reported), this is considered a moderate level in the amount and complexity of data to be reviewed category.

B

If a provider discusses the patient's condition with the nurse on duty for a patient in the hospital, this qualifies for a moderate level in the amount and complexity of data to be reviewed category.

C

When a provider changes medication, this is an automatic moderate level MDM

D

When the presenting problem is considered acute and uncomplicated, the provider orders three lab tests and states " Order Diflucan today, patient may wait to fill, will call with results". This is a moderate level based on two of the three categories.

E

A and D are both true statements

F

C and D are both true statements

G

None of the above are true statements

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