Evaluation and Management: Are You Coding Correctly?

November 21, 2017

Novitas recently reported in a study report, the Office of the Inspector General (OIG) noted that 42 percent of claims for Evaluation and Management (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

Novitas recommends the use the following resources to bill correctly for E/M services:

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