Bill 99214 and 99215 when documentation supports it

Why This Topic Matters

It explains why some pediatric practices may underreport higher-level E/M services and why accurate documentation and internal coding review matter for compliance and revenue integrity.

Article Sections

1. Coding distribution patterns in pediatric E/M services

   Describes the general pattern of pediatric evaluation and management coding and the idea of comparing a practice’s distribution to broader specialty norms. It also introduces internal bell curve review as a practice-management concept.

2. Documentation justifies codes

   Focuses on the relationship between what is documented and the level of service reported. It also addresses the importance of reflecting work performed and the risk of unsupported reporting.

3. Don’t fear an audit

   Discusses audit concerns, outlier review, and why practices should rely on documentation rather than benchmarking pressure alone. It also covers the role of insurer comparisons and internal coding assessment.

4. Disproportionate pediatric bell curve

   Presents an example of pediatric E/M distribution patterns reported by a consulting firm’s clients. The section is used to illustrate variation in reporting across code levels.

5. Use time-based coding when appropriate

   Covers counseling and time-based evaluation and management reporting as a general subject. It notes that visit time and charted time frames are relevant when time-based methods are used.