• Comparison between study ordered vs. study performed.
• Documentation assessment for determining appropriate CPT code documented vs. CPT code billed
• Documentation assessment for determining appropriate medical necessity (ICD-9 code) for each diagnostic and interventional radiology service rendered vs. ICD-9 code billed
• Identification of opportunities to improve physician documentation regarding medical necessity and services provided.
   

Audit Scope and Approach

Client will need to supply SMM with the following for all diagnostic and interventional radiology services to be audited:

• Copy of all treating physician orders for all selected cases. 
• Written documentation for all of the selected cases, either paper or electronic access
• Original CPT and ICD-9 codes assigned by Client’s coders

Upon completion of the assessment, the reviewer will:

• Provide audit spreadsheet for all reports reviewed showing CPT & ICD-9 codes billed vs codes that should have been billed
• Provide a written Executive Summary of issues, “at risk” situations, and implementation recommendations
• Provide copies of all regulations cited throughout Executive Summary

In all cases, patient records will be maintained as confidential. SMM acknowledges that its services involve personal, medical, and other confidential information obtained by SMM while performing these services, and that this information is proprietary in nature and is the exclusive property of Client. SMM shall not use this information for any purpose or share this information with any individual, entity or group, other than Client, in accordance with HIPAA regulations.

Professional Staff and Qualifications

Auditing will be performed only by SMM employees currently maintaining a national coding certification and having diagnostic and interventional radiology coding experience.