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Medicare Compliance & Reimbursement

E/M Coding:

Don't Bill High-Level E/M Codes Until You Read This

Published on Sat Apr 10, 2010

Sicker patients may not always mean higher MDM. If your physician bills a lot of high-level office visits, he may be at risk of an audit -- which may not be cause for concern -- if his documentation justifies his code choices. "Some physicians believe their patients are sicker than others', so they feel they're justified using more 99215s, when in fact that may not be the case," says Crystal S. Reeves, CPC, CPC-H, consultant with Coker Group in Alpharetta, Ga. "The CPT manual outlines the requirements of the E/M codes, there are clinical examples in the back of CPT, and CMS publishes a Table of Risk that can help guide you, so use all of those resources to determine whether you're billing properly," she advises. Training is key: If you advise your physician that he is overbilling the high-level codes and he says, "But all of our patients are really sick," [...]
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