decisionhealth Newsletters, Part B News - 2011 Issue 9 (September)
Analysis: Shift from level 2 and 3 E/Ms toward 4s and 5s is speeding up
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Article Overview
This article reviews an analysis of 2010 CMS Part B claims data focused on evaluation and management office visit utilization trends. It is relevant to coders, compliance staff, and revenue cycle professionals who track how E/M coding patterns change across new and established patient services and how broader policy changes may affect billing volume and denial rates. The article presents trend data by service level and discusses how shifts in practice patterns relate to changes in reported utilization.
Why This Topic Matters
Understanding shifts in E/M billing patterns helps coding and compliance teams monitor documentation and coding behavior, benchmark utilization, and anticipate the operational impact of policy changes on office visit claims.
What You Will Learn
- How E/M office visit utilization changed across service levels over multiple years.
- How CMS claims data can be used to observe billing mix trends for new and established patient visits.
- How changes in policy context may coincide with shifts in reported billing volume and denial patterns.
- How service-level distribution trends are described for higher-level versus lower-level E/M visits.
Who Should Read This
- Medical coders
- Coding auditors
- Compliance professionals
- Revenue cycle staff
- Physician billing staff
Codes Discussed
Code Ranges Discussed
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