Understanding E/M: Lessons from a recent MAC audit

Why This Topic Matters

It helps readers assess whether their own established patient E/M documentation is likely to withstand payer review and understand the kinds of documentation weaknesses that can trigger audit findings.

Article Sections

1. Audit overview and findings

   Summarizes the scope of the contractor review, the states involved, and the general audit outcome for established patient E/M claims.

2. Medical necessity in question

   Discusses payer concerns about the reason for the visit, follow-up timing, and whether the documented service appeared appropriate for the presenting problem.

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

   Explains the broader documentation themes involving history, review of systems, examination, and medical decision-making in relation to the visit’s complexity.

4. TrailBlazer's examples of bad and good E/M notes

   Presents the instructional documentation examples referenced by the article and the contrast between less effective and improved note structure.