Benchmarking: How Would Your 99285 Coding Stand up in An Audit?

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Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This article explains a Medicare Comparative Billing Report focused on emergency department billing trends and benchmark comparisons across practices and states. It is aimed at coders, compliance staff, and emergency medicine providers who want to understand how their billing patterns compare with peers and what broad documentation areas are being examined in audit-related review. The discussion centers on E/M coding trends, modifier usage, and the general documentation themes highlighted by the report and webinar.

Why This Topic Matters

Understanding peer billing benchmarks can help emergency department organizations assess whether their coding patterns differ from broader Medicare trends and identify areas that may warrant internal review.

Article Sections

  1. Background and purpose of the Comparative Billing Report

    Introduces the Medicare report, why it was created, and the broader billing trend topics it was intended to analyze. It also explains the general role of comparative billing data in reviewing emergency medicine claims.

  2. Findings from the report and webinar

    Summarizes the types of benchmark data discussed in the report and webinar, including state-level variation and the categories of claim characteristics examined. The section also notes that practice differences may reflect a variety of broad factors.

  3. Documentation considerations for high-level ED E/M reporting

    Reviews the general documentation elements associated with higher-level emergency department evaluation and management reporting. It also discusses the special documentation circumstance highlighted for emergency department history collection.

  4. Resource

    Provides a reference link for readers who want to view the underlying comparative billing report and related materials.

What You Will Learn

  • How a Comparative Billing Report can be used to benchmark emergency department billing patterns
  • What broad claim characteristics were analyzed in the Medicare emergency medicine report
  • Which general documentation areas are highlighted in relation to high-level ED E/M reporting
  • How comparative billing data may be used for internal review and compliance awareness

Who Should Read This

  • Emergency department coders
  • Compliance and audit staff
  • Revenue cycle professionals
  • Emergency medicine physicians
  • Practice managers

Codes Discussed

Modifiers Discussed


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