1. 1 RED FLAGS Things that may cause your files to be audited.

2. 2 BILLING INAPPROPRIATE CODES z 99205 - don’t use z 99211/99212 - don’t use as a daily visit code CAN BE VIEWED AS FRAUD

3. 3 z97112 - NMR zThis is typically used by chiropractors to denote trigger point work. However it is a code designed to be used with re- educating a limb after a severe injury.

4. 4 z99242 & 99244 zThese are codes used for a consultation with another provider to coordinate care, not as a new patient consultation code.

5. 5 z99203 & 99204 zThese codes are used for new patients that haven’t been seen in that office for at least three years, or never before.

6. 6 z99212 & 99213 zThese codes are for the existing patient or for re-exams.

7. 7 BILLING INAPPROPRIATE X-RAYS zX-rays that are outside the area of chief complaint. zFull spine x-rays not diagnostic for trauma zUnbundling of x-rays zRepeat studies zRepeating films that were recently taken at another facility.

8. 8 MULTI-DISCIPLINE OFFICES GOOD IDEA THAT GETS ABUSED OFTEN

9. 9 EXTENDED CARE zCare past 6-12 weeks with minor incident. zCare past 12-18 weeks with moderate injury. zNo re-exams to justify extended care. zNo real change in condition in objective or subjective areas. zNo referral with difficult or non-responsive patient.

10. 10 MULTIPLE THERAPIES zTherapies such as ultrasound, e-stim, diathermy, and heat have similar therapeutic effects. zMost of these therapies have a maximum therapeutic effect in 10-15 applications. zPassive use of therapies leads to chronicity.