Downcoding: You Could Be Selling Yourself Short 14.4 Percent Of The Time

Article Overview

This article discusses CMS audit findings on evaluation and management (E/M) claims, focusing on how often documentation supported different coding levels and the broader effect on Medicare payments. It is aimed at coders, billers, auditors, compliance staff, and clinicians who work with professional claims and need to understand the prevalence of coding mismatches, the types of E/M services involved, and the significance of documentation review. The piece also places the findings in a year-over-year context and references CMS observations about undercoding and claim review outcomes.