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E/M Coding

STRATEGIES FOR CORRECT E/M CODING

Despite of having proper guidelines, coding for Evaluation and Management (E/M) services is still a challenge for healthcare service providers. CMS reported that more than 15% of E/M services were improperly paid due to over or under coding of these services. Due to higher rates of errors, Reimbursement for providers has declined over the years. E/M coding errors results in claim denials which financially affects both the organization and practitioner.

There are number of strategies that will help you prevent your E/M claim denials:

  1. The reason for the visit should be properly stated.
  2. The history of the present illness should be described in such a manner that the nature of the problem is clear.
  3. Thoroughly study the documentation guidelines that specify elements to be recorded about the present illness.
  4. Unnecessary information should not be recorded to meet requirements of a high-level service when the nature of the visit is lower to have been medically appropriate.
  5. Record the Review of Systems (ROS) appropriate for the clinical circumstance of the encounter.
  6. Document an ROS for the system/systems related to the presenting problem. It is required for all for all codes except the least codes in all code families.
  7. Record both positives and negatives related to the presenting problem. Use notations such as “normal” or “negative” only for systems not related to the presenting problem.
  8. Record all the important impressions, tentative diagnoses, confirmed diagnoses and all therapeutic options related to every problem for which Evaluation and Management (E/M) is clearly demonstrated in the record of the other key components.
  9. Document all ordered diagnostic tests, reviewed and independently visualized as part of the work of the encounter.

Tips for Preventing Coding Errors:

  1. Understand Current Procedural Terminology (CPT) code requirements.
  2. All of the following codes require comprehensive history and comprehensive examination: – 99204 and 99205 (New patient office services). – 99222 and 99223 (Initial hospital services). – 99244 and 99245 (Office consultations). – 99254 and 99255 (Initial in-patient consultations).
  3. Proper attention should be given to the unique record kept in Emergency Departments (EDs).
  4. Physician coding should be based on the physician’s own Evaluation and Management (E/M) work.
  5. While coding for E/M services attention to medical necessity should be given. When coding, consider contributory factors and/or other patient status descriptions.

The message from Medicare Administrative Contractors (MACs) is that E/M services are a top contributor to the Comprehensive Error Rate Testing (CERT) error rates, and that there is an obvious need for education among providers.

 

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Despite of having proper guidelines, coding for Evaluation and Management (E/M) services is still a challenge for healthcare service providers. CMS reported that more than 15% of E/M services ...
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