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.