Reminder About Correct Coding of E/M Services

The Centers for Medicare & Medicaid (CMS) issued a reminder about correct coding of Evaluation and Management (E/M) services. As part of their reminder, they mentioned a study report the Office of the Inspector General (OIG) that noted 42 percent of claims for E/M services in 2010 were incorrectly coded, which included both upcoding and downcoding (i.e., billing at levels higher and lower than warranted), and 19 percent were lacking documentation.

  • A number of physicians increased their billing of higher level, more complex and expensive E/M codes
  • Many providers submitted claims coded at a higher or lower level than the medical record documentation supports

Do you want to learn more about E/M coding?

We recently published a white paper that includes additional information about upcoding, downcoding and documentation. We also have an Evaluation and Management Basics learning module that that can help you understand general principles of E/M coding.

Do you need additional E/M support?

Healthcare Compliance Pros offers a Coding Plus program where we develop an audit strategy for reviewing patient encounters, documentation and coding generated.

Contact us today to receive a copy of our E/M white paper, for access to our Evaluation and Management Basics learning module, or to learn more about our Coding Plus program.

Reach us by email: [email protected] or by phone: 855-427-0427.

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