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January 25, 2018

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Where to train: E/M coding has the biggest return on investment

February 9, 2017:

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 Error rate
Office/outpatient visit, est. (99214) 5.50%
Subsequent hospital care (99233) 16.80%
Office/outpatient visit, est. (99215) 18.60%
Office consultation (99244) 17.50%
Initial hospital care (99223) 12.70%
Inpatient consultation (99254) 15.50%
Subsequent hospital care (99232) 3.50%
Office/outpatient visit, est. (99213) 1.70%
Inpatient consultation (99255) 17.70%
Office/outpatient visit, new (99204) 20.80%
Office consultation (99245) 19.10%
Office consultation (99243) 9.60%
Emergency dept. visit (99285) 5.40%
Office/outpatient visit, new (99203) 10.40%

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/.


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