ED Coding & Reimbursement Alert - 2017 Issue 6
You Be the Coder: Understand Exam Levels for Other MACs
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Article Overview
This article covers Medicare administrative contractor guidance relevant to E/M physical exam leveling for practices seeing patients in New Jersey and Pennsylvania. It is aimed at coders, auditors, and billing staff who need to understand how one MAC applies audit review frameworks, including older documentation guidelines and reviewer judgment considerations. The discussion focuses on general policy structure and review approach rather than code-specific instructions.
Why This Topic Matters
Understanding local MAC audit expectations helps practices document E/M exams in a way that aligns with payer review methods and supports defensible coding.
What You Will Learn
- Which MAC jurisdiction applies to New Jersey and Pennsylvania
- How one MAC approaches audit review of physical exam documentation
- What broad guideline frameworks are referenced in the discussion
- How reviewer judgment factors into exam-level assessment
Who Should Read This
- Medical coders
- Certified professional coders
- Billing staff
- E/M auditors
- Compliance staff
- Physicians and practice managers
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