E/M Coding: CMS Continues to Focus on E/M Problem Areas

Why This Topic Matters

E/M services are a major source of Medicare billing volume and improper payment findings, so understanding CMS audit priorities helps practices reduce denials, support documentation, and improve compliance.

Article Sections

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

   Discusses CMS concerns about selecting the appropriate evaluation and management level and the kinds of coding confusion that can lead to claim issues. Includes guidance-related discussion and an illustrative example focused on office/outpatient E/M services.

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

   Covers documentation sufficiency, medical necessity, and audit concerns tied to higher-level E/M selections. Also addresses how record content and coding support are evaluated in compliance review contexts.

3. Hospital Admissions Trump Office E/M

   Addresses place-of-service and admission-related E/M billing concerns when care spans office and hospital settings. Includes discussion of initial and subsequent hospital care within CMS and CPT guidance.