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February 14, 2018

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E/M is the foundation of practice revenue and the key to ICD-10-CM coding accuracy

March 14, 2016:

Evaluation and management (E/M) services make up a very significant portion of physician practice revenues. CMS statistics note that total Medicare physician expenditures were $71 billion in 2014. But E/M services during the same period were $28 billion. That’s 39 percent overall. And for some specialties, like Family Practice or General Practice, E/M makes up 60 percent of total practice revenue.

Because of E/M’s contribution to practice revenue, the Office of Inspector General (OIG) includes E/M services in the agency’s annual work plan as an area of continued investigative review.

The ICD-10 connection

Attention to E/M services is directly linked to accurate ICD-10-CM coding. Only by capturing all relevant information required for E/M codes can the proper ICD-10-CM code be assigned. Poor E/M documentation= poor documentation for ICD-10 code assignment.

Before ICD-10, we needed to know why the patient was being seen. We still need to know that, but we might need to know more. With the implementation of ICD-10-CM, additional details, such as acute vs. chronic, which side of the body is affected (i.e., right or left), cause and effect relationship (anemia due to iron deficiency), as well as determining if the condition or injury is a new problem or a late effect (sequela) and how many times the patient has been seen at the practice for this problem, all become critical elements of information about the patient encounter.

Examples of chief complaints, along with the corresponding diagnosis code description and/or additional information needed to determine code selection based on which code set is used are shown in the following table.

The 2016 Evaluation and Management Coding Advisor provides detailed guidance on all E/M code assignments. For more information see:



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