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
