decisionhealth Newsletters, Coder Pink Sheets - 2016 Issue 6 (June)
Understanding E/M: High-level E/Ms without MDM possible, but will be challenged by auditors
Subscribe or sign in to view the full article.
Article Overview
This article explains a coding and compliance question for established patient evaluation and management services: whether a high-level visit can be supported without high medical decision-making. It compares general CPT-based guidance with Medicare contractor review practices and discusses the role of medical necessity, payer scrutiny, and documentation review for coders, auditors, and billing staff.
Why This Topic Matters
Understanding how payers evaluate higher-level E/M claims helps coders and auditors assess documentation risk, support medical necessity, and anticipate denials or downcoding during review.
What You Will Learn
- How established patient E/M level selection is discussed in relation to the traditional key components
- How payer review may differ from general CPT-based coding guidance
- Why medical necessity is emphasized in audits and claim review
- What documentation areas are commonly reviewed when higher-level E/M services are challenged
Who Should Read This
- Medical coders
- Coding auditors
- Billing staff
- Compliance professionals
- Physicians and clinical documentation staff
Codes Discussed
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com