In a study report about how “Improper Payments for Evaluation and Management Services Cost Medicare Billions in 2010,” the Office of the Inspector General (OIG) noted 42 percent of claims for Evaluation and Management (E/M) services were incorrectly coded and 19 percent lacked documentation.
This included both upcoding, with a number of physicians increasing billings of higher level, more complex and expensive E/M codes, and undercoding, with providers coding at a lower level than their medical record documentation supports.
Use these following resources to bill correctly for E/M services:
- OIG Report: Improper Payments for Evaluation and Management Services
- 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 Evaluation and Management (E/M) Services
- Evaluation and Management Services Web-Based Training course available through the MLN LMS
For more information about the CMS Medical Learning Network, go to mlnConnects.
