Transcription of E/M Documentation Auditors’ Worksheet
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E/M Documentation Auditors’ Worksheet
E/M Documentation Worksheet pg. 1 Created 09/15/00 Revised 12/26/00 E/M Documentation auditors Worksheet Patient s ID/MR #: _____ Physician s Name and/or ID#: _____ Resident yes no Staff Physician s Name and/or ID#(if resident is used): _____ Date of Service Billed: _____ Actual Date of Service: _____ Level of Service Determination: Outpatient, Consults (Outpatient, Inpatient & Confirmatory) and ER: New Patient Outpt Cons Inpt Cons ER Established Level of Service Determination: INPATIENT Initial Hospital Observation Subsequent Inpatient Follow-up Consult Level of Service Determination: Nursing Facility Annual Assessment Admission Subsequent Nursing Facility Level of Service Determination: Domiciliary (Rest Home Custodial Care) and HOME CARE New Establish
E/M Documentation Worksheet pg. 1 ... Revised 12/26/00 E/M Documentation Auditors’ Worksheet Physician’s Name and/or ID ... Initial Audit Date Physician Notified ...
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