Studies conducted by CMS show that E/M services are very prone to problems, namely insufficient or no documentation, over coding and under coding. Further, a recent study by a Medicare carrier found error rates as high as 44% for some E/M services.
What’s the problem with E/M coding? Simply, coders and clinicians who code have trouble selecting the correct code from among a range of seemingly appropriate choices, given the documentation in the record. The resulting high error rates make E/M coding the most appropriate place for investing in education and training.
|Incorrect coding for E/M services ||
|Office/outpatient visit, est. (99214) ||
|Subsequent hospital care (99233)||
|Office/outpatient visit, est. (99215)||
|Office consultation (99244) ||
|Initial hospital care (99223) ||
|Inpatient consultation (99254)||
|Subsequent hospital care (99232) ||
|Office/outpatient visit, est. (99213)||
|Inpatient consultation (99255)||
|Office/outpatient visit, new (99204) ||
|Office consultation (99245) ||
|Office consultation (99243) ||
|Emergency dept. visit (99285) ||
|Office/outpatient visit, new (99203) ||
Some E/M services have the most improper payments of all billed services.
Source: Improper Medicare Fee-for-Service Payments, May 2008, CMS
E/M services are the most frequently reported clinical services to any payer, in addition to being the biggest contributor to practice revenue for most specialties.
What’s the best investment for E/M coding improvement? Consider the 2017 Evaluation and Management Coding Advisor. This manual is designed to ensure appropriate code selection and determine if the medical record supports the level of E/M selected.
Key features include:
- Review of every E/M service
- Clinical vignettes that illustrate real-life coding issues
- Multiple-choice exams for each E/M segment; answer rationale explains why the answer is the most appropriate choice
- Concise, thorough documentation requirements for all E/M codes
For more information about the 2017 Evaluation and Management Coding Advisor, visit https://www.optum360coding.com/Product/46261/.