Growth in E/M use heavily favors higher level codes

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Note:  The following article synopsis was NOT provided by HCPro. It was created by Find-A-Code/innoviHealth.

Article Overview

This article examines Medicare Part B billing patterns for evaluation and management services across multiple years, focusing on changes in utilization, denial rates, and the distribution of visits among common established-patient and new-patient code families. It is relevant to physicians, coders, compliance staff, and practice administrators who track E/M documentation, coding patterns, and payment trends.

Why This Topic Matters

The article helps readers understand broader utilization shifts that can affect documentation review, compliance attention, and Medicare spending patterns without assuming the full article has been read.

Article Sections

  1. Billing trends and practice perspectives

    Summarizes Medicare billing pattern changes and includes commentary from practice coding professionals on documentation, education, and compliance considerations.

  2. Denial rates remain steady

    Reviews denial patterns for established-patient evaluation and management services over time and compares year-to-year rates.

  3. Most-billed code sees slight decline

    Discusses how the most frequently billed code changed in volume and places that change in the context of longer-term E/M utilization shifts.

  4. E/M billing patterns for new and established patient visits, 2000-2005

    Presents a tabular comparison of billing volumes and percentage changes for commonly used new-patient and established-patient visit codes across multiple years.

What You Will Learn

  • How Medicare E/M billing patterns changed over time
  • How denial rates are discussed in relation to established-patient visit services
  • How new-patient and established-patient visit groups are compared across years
  • What kinds of practice-level factors are associated with shifts in E/M coding behavior

Who Should Read This

  • Physicians
  • Medical coders
  • Compliance staff
  • Practice administrators
  • Billing staff

Codes Discussed

Code Ranges Discussed


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