Evaluation and Management Coding Tips / Review EM patterns outside the norm

Article Overview

This premium article explains how evaluation and management (E/M) billing patterns may be flagged for review when a provider appears unusual compared with peers. It is aimed at coders, compliance staff, auditors, and practice managers who want to understand common data-mining approaches, how peer comparisons are used, and why documentation quality matters in defending billing patterns. The guidance is focused on reviewing utilization trends, comparing like-to-like providers, and recognizing documentation issues that can affect audit risk.