Regulatory update


Evaluation and Management: Correct Coding Crucial for Compliance


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:


For more information about the CMS Medical Learning Network, go to mlnConnects.




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