2025 Auditors’ Desk Reference (Softbound)
Optum | 2024 |
This unique manual shows what the medical record must contain for correct coding and billing of specific medical and diagnostic services and procedures. It provides coders and anyone concerned about coding with an auditor’s perspective on the clinical detail, regulatory instructions, and coding protocol needed for code assignment. Avoid the devastating effects of outside audits and reviews with this detailed coding tool.
• Optum Edge — Get online access to customizable audit worksheets. Protect your revenue-critical services and procedures.
• Conduct skilled internal audits. Ensure proper reimbursement.
• Differentiate between similar procedures. Compare and contrast seemingly similar, but different, procedures.
• Completely updated for 2025 code set and regulatory changes.
• Increase Revenue. Learn the appropriate way to report telehealth services.
• Provides coders with an auditor’s perspective. Know the clinical detail, regulatory instructions, and coding best practices needed for code assignment.
• Know what information needs to be in the medical record and on the claim form to capture appropriate reimbursement.
• Know the key terms that need to be mentioned in the medical record to support code assignment.
• See the medical conditions that are indicated for diagnostic, therapeutic, and surgical purposes.
• Gain valuable code intelligence. Confirm the correct code assignment.
• Train your staff. This resource is thorough and can easily be used to train staff on how to assign codes appropriately.
• Correct modifier assignment. Modifier decision-making trees assist with assigning correct modifiers.
• Supports Best Practices.
• Conduct skilled internal audits. Ensure proper reimbursement.
• Differentiate between similar procedures. Compare and contrast seemingly similar, but different, procedures.
• Completely updated for 2025 code set and regulatory changes.
• Increase Revenue. Learn the appropriate way to report telehealth services.
• Provides coders with an auditor’s perspective. Know the clinical detail, regulatory instructions, and coding best practices needed for code assignment.
• Know what information needs to be in the medical record and on the claim form to capture appropriate reimbursement.
• Know the key terms that need to be mentioned in the medical record to support code assignment.
• See the medical conditions that are indicated for diagnostic, therapeutic, and surgical purposes.
• Gain valuable code intelligence. Confirm the correct code assignment.
• Train your staff. This resource is thorough and can easily be used to train staff on how to assign codes appropriately.
• Correct modifier assignment. Modifier decision-making trees assist with assigning correct modifiers.
• Supports Best Practices.
Jaqueline Petersen, MHA, RHIA, CHDA, CPC
Ms. Petersen is a subject matter expert (SME) with Optum360. She has served as Senior Clinical Product Research Analyst with Optum360 developing business requirements for edits to support correct coding and reimbursement for claims processing applications. Her experience includes development of data-driven and system rules for both professional and facility claims and in-depth analysis of claims data inclusive of ICD-10-CM, CPT®, HCPCS and modifiers. Her background also includes consulting work for Optum, serving as a SME, and providing coding and reimbursement education to internal and external clients. Ms. Petersen is a member of the American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA).
CPT is a registered trademark of the American Medical Association.
CPT is a registered trademark of the American Medical Association.
Tara Rose, CPC-I, CPMA, RHIA, CCS-P, AHIMA- approved ICD-10-CM/PCS Trainer
Ms. Rose has more than 15 years of experience in the healthcare profession. She has extensive experience in auditing, teaching, physician billing, and multi-specialty coding with experience in coding CPT, HCPCS, and ICD-10-CM. Most recently Ms. Rose was a post payment auditor and coding consultant. She also taught coding to physicians and at a local community college. Ms. Rose has been a member of her local American Academy of Professional Coders (AAPC) chapter and the American Health Information Management Association (AHIMA) for many years.
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