medical-coding-audit

# Medical Coding Audit Review clinical documentation and assigned codes for accuracy, compliance, and optimization, identifying documentation improvement opportunities and coding errors. ## Overview This skill enables auditing of medical coding accuracy and compliance. It encompasses documentation review, code validation, error identification, and improvement recommendations to ensure accurate reimbursement and regulatory compliance. ## Capabilities ### Code Review - ICD-10-CM/PCS validation - CPT/HCPCS verification - Modifier appropriateness - Sequencing accuracy - Specificity assessment ### Documentation Analysis - Clinical support review - Query identification - Documentation gaps - Clarity assessment - Medical necessity ### Compliance Validation - Coding guidelines adherence - Payer rules compliance - Fraud and abuse screening - Audit trail review - Regulatory requirements ### Error Identification - Upcoding detection - Unbundling identification - Missing charges - Incorrect modifiers - Sequencing errors ## Usage Guidelines ### Audit Process 1. Select audit sample 2. Review documentation 3. Validate code assignments 4. Identify discrepancies 5. Document findings 6. Calculate accuracy rates 7. Provide recommendations ### Audit Types - Pre-bill audits - Post-payment audits - Focused audits - Random sampling - Targeted reviews ### Documentation Standards - Detailed audit worksheets - Finding classifications - Trend analysis - Education recommendations - Follow-up...