Medical Auditing Practice Exam

What reference is needed to conduct an audit of claims coded as 99244, as requested by an infectious disease provider?

1. ICD-10 Guidelines

2. CPT® Evaluation and Management (E/M) Services Guidelines

3. Medicare Billing Guidelines

4. Current Procedural Terminology (CPT) Index

The correct answer is: CPT® Evaluation and Management (E/M) Services Guidelines

When conducting an audit of claims coded as 99244, the appropriate reference is the CPT® Evaluation and Management (E/M) Services Guidelines. This is because 99244 is a specific code used for an office or other outpatient visit for an established patient, which requires familiarity with the guidelines that define how to properly select and use evaluation and management codes based on the components of the visit. The CPT® E/M Services Guidelines provide critical information on the elements that are necessary to justify the use of this code, including the complexity of the visit, the level of history taken, the examination performed, and the medical decision-making involved. Understanding these guidelines allows auditors to assess whether the claims have been accurately coded in accordance with established standards. While other references like the ICD-10 Guidelines and Medicare Billing Guidelines are important in their own right, they do not specifically address the nuances of E/M coding which is essential for determining the appropriateness of the 99244 claim. The Current Procedural Terminology (CPT) Index, while beneficial for looking up codes, does not provide the comprehensive explanation and criteria for how to apply those codes in practice. Therefore, the CPT® Evaluation and Management (E/M) Services Guidelines are the most relevant and necessary resource for