Procedural

1.800.972.9298 (option 2)

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PRS procedural encounter audits includes the identification of the procedures performed during a single operative session and the determination of which of the procedures are appropriate to bill . The reviewer will review the CPT code definition, CPT parenthetical notes and CPT section guidelines, general Medicare rules i.e. code statue, bilateral, add -on etc. Medicare bundling edits and global rules, and national and local coverage determinations as they apply to the specific patient. Modifiers will be applied as required. The client is asked to submit the EOB and the office coded procedural encounter. The client will receive a written report containing the final coding with an explanation of why the specific codes and modifiers were chosen.

Prices

  • Pre-coded encounters are $80 per encounter
  • Non pre-coded encounters are $90 per encounter