Evaluation and Management: Are You Coding Correctly?

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:

• Improper Payments For Evaluation and Management Services OIG Report
• Claims Processing Manual: Chapter 12, Section 30.6
• E/M Services Guide
• 1995 Documentation Guidelines for E/M Services
• 1997 Documentation Guidelines for E/M Services
• Frequently Asked Question on Use of 1995 and 1997 Guidelines
• Provider Compliance Tips for E/M Services Fact Sheet
• E/M Services Web-Based Training course available through the Learning Management System

About the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.