E/M Coding: Incorrect Codes, Poor Notes, and Setting Debacles Add to E/M Fails

Why This Topic Matters

E/M services are a frequent source of Medicare payment errors and audit scrutiny, so understanding the article helps readers recognize the broad categories of claim risk CMS is monitoring and the general compliance themes emphasized in its newsletter and related guidance.

Article Sections

1. CMS sees uptick in E/M claims problems

   Introduces the Medicare compliance context and the broad E/M claim issues highlighted by CMS. It frames the article around recurring payment and documentation concerns.

2. Use the Right E/M Code for the Service

   Covers general issues related to matching the billed service level to the medical record and patient category. It also discusses common confusion around E/M selection in outpatient settings.

3. Ensure Documentation Supports a Higher-Level Code and Medical Necessity

   Focuses on documentation sufficiency, medical necessity, and audit review concerns. The section also addresses problems that can arise when electronic records and service levels do not align with the documented encounter.

4. Hospital Admissions Trump Office E/M

   Discusses setting-related E/M billing issues when care spans office and hospital locations on the same day or across consecutive days. It explains the broader compliance focus on correctly reporting care tied to inpatient admission and follow-up.