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Primary Care Coding Alert

E/M Coding:

Steer Clear of OIG Scrutiny With Pointers for Legitimate High-Level Codes

Published on Mon Jun 04, 2012

OIG report on 99214 and 99215 increase means you need to be extra careful. Reporting high-level E/M codes doesn't automatically point to fraud, but you want to ensure those higher codes are justified -- particularly if a federal auditor pays you a visit. Big red flag: A recent OIG report found that family physicians were among the groups of doctors who increased their billing of higher-level E/M codes across all categories (inpatient, outpatient, etc.) between 2001 and 2010. Read on for expert advice on how to stay above board with E/M codes. Determine the Physical Exam Level One step in successful E/M coding is to determine the physical examination key component for the encounter. E/M coding guidelines help you determine which of the following four levels of examination the physician completes during an encounter: Problem-focused Expanded problem-focused Detailed Comprehensive. The level of exam is a factor in determining which code you [...]
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