Primary Care Coding Alert

Trap: You might not only be losing revenue -- you're also coding improperly.National insurer data shows that physicians undercode E/M claims to the tune of more than $1 billion annually. That's money physicians could have collected based on their documentation but missed out on because they reported a lower-level E/M code than they should have. Read on for three reasons to always file claims based on the physician's documentation instead of "playing it safe" with lower-end codes.1. Staying Low Doesn't Keep You Below RadarIf you shy away from upper level E/M codes because you don't want to trigger an audit, remember this: Reporting all low-level codes will also get a payer's attention, because reviewers will wonder why your physician never offers high-level examinations. When claims reviewers review "bell curves" to determine whether a practice is coding outside the norm, they aren't just looking for upcoding -- they are looking at trends across [...]