Understanding E/M: Lessons from a recent MAC audit

Why This Topic Matters

The article helps readers gauge whether their established patient E/M documentation aligns with payer expectations and why documentation quality can affect audit outcomes and reimbursement review.

Article Sections

1. Audit findings and education context

   Introduces the TrailBlazer audit results and the related educational material released for providers. It frames the broader documentation concerns without detailing the coding rules.

2. Medical necessity in question

   Discusses the visit rationale and how the payer viewed the documentation supporting the encounter. The section focuses on the theme of medical necessity and documentation clarity.

3. ROS and exam must match level of care for presenting problem

   Explains the relationship between the documented history, review of systems, examination, and the overall level of service. It emphasizes alignment between the visit record and the patient’s presenting issue.

4. Examples of bad and good E/M notes

   Presents paired documentation examples from the instructional material to illustrate general improvement themes. The section is centered on comparing documentation styles rather than on specific coding instructions.