# Medical Coding Audit

> Review clinical documentation and assigned codes for accuracy, compliance, and optimization, identifying documentation improvement opportunities and coding errors

- Skill: `a5c-ai/medical-coding-audit` (Agent Skill)
- Install (CLI): `npx skillmds@latest add a5c-ai/medical-coding-audit`
- Raw SKILL.md: https://api.skillmd.com/api/skills/a5c-ai/medical-coding-audit/raw
- Safety review: pending (external: skill-scanner PASS, skillspector PASS)
- Works with: Claude Code, Claude.ai, OpenAI Codex
- Category: Security
- Author: a5c-ai (https://skillmd.com/u/a5c-ai)
- Updated: 2026-09-09
- Page: https://skillmd.com/skills/a5c-ai/medical-coding-audit

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# Medical Coding Audit

Review clinical documentation and assigned codes for accuracy, compliance, and optimization, identifying documentation improvement opportunities and coding errors.

## Overview

This skill enables auditing of medical coding accuracy and compliance. It encompasses documentation review, code validation, error identification, and improvement recommendations to ensure accurate reimbursement and regulatory compliance.

## Capabilities

### Code Review
- ICD-10-CM/PCS validation
- CPT/HCPCS verification
- Modifier appropriateness
- Sequencing accuracy
- Specificity assessment

### Documentation Analysis
- Clinical support review
- Query identification
- Documentation gaps
- Clarity assessment
- Medical necessity

### Compliance Validation
- Coding guidelines adherence
- Payer rules compliance
- Fraud and abuse screening
- Audit trail review
- Regulatory requirements

### Error Identification
- Upcoding detection
- Unbundling identification
- Missing charges
- Incorrect modifiers
- Sequencing errors

## Usage Guidelines

### Audit Process
1. Select audit sample
2. Review documentation
3. Validate code assignments
4. Identify discrepancies
5. Document findings
6. Calculate accuracy rates
7. Provide recommendations

### Audit Types
- Pre-bill audits
- Post-payment audits
- Focused audits
- Random sampling
- Targeted reviews

### Documentation Standards
- Detailed audit worksheets
- Finding classifications
- Trend analysis
- Education recommendations
- Follow-up tracking

## Integration Points

### Related Processes
- Medical Coding Compliance
- Clinical Documentation Improvement
- Claims Management Workflow

### Collaborating Skills
- clinical-documentation-query
- revenue-cycle-analytics
- regulatory-compliance-assessment

## References

- ICD-10-CM Official Guidelines
- CPT coding guidelines
- CMS coding policies
- OIG compliance guidance