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audit

Aida Posted Fri 04th of May, 2012 23:34:34 PM

How does the Marshall Audit sheet work, there are codes at the end of each sheet. what do they mean?

SuperCoder Answered Mon 07th of May, 2012 11:49:17 AM

Hi Aida,

I am forwarding your query to our director of supercoder.com, Jennifer Godreau, BA, CPC, CPMA, CPEDC and she will guide for this query.

SuperCoder Answered Mon 07th of May, 2012 13:00:58 PM

Hi, Aida,

You have to determine the code level requirements met for each component of history, exam, and medical decision making. You enter the determined level in total at the end and then pick the lowest code for Evaluation and management services that require 3/3 and the middle code for EM services that require 2/3. Most compliance officers recommend using the 1995 or 1997 CMS guidelines which are an evolution of the Marshfield audit tool. The CMS guideline worksheets are easier to follow. Also, on 2/3 still consider nature of presenting problem in determining if all documented history and exam were medically necessary based on the presenting problem.

Jen Godreau

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