Medical Record Review Results

Noridian Medical Review (MR) has analyzed findings as a result of Targeted Probe and Educate (TPE) review. The goal of MR is to reduce claim errors by identifying services with top trending errors and providing relevant education. MR encourages providers to review this information to ensure compliance with documentation, billing, and coding guidelines.

Review Criteria Required Documentation Current Error Rate Review Results
CPT® 97530: Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes Outpatient Therapy Documentation Requirements 54.39%
CPT® 99215: Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded Evaluation and Management Documentation Requirements 42.32%
CPT® 71046: Radiologic examination, chest; 2 views Radiology Documentation Requirements 35.53%
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