tci Medicare Compliance & Reimbursement - 2011 Issue 11

E/M Coding: Answer the $56 Question -- Are You Downcoding Your E/M Visits?

You're not only losing revenue--you're also coding improperly. CMS data from previous years shows that medical practices undercode E/M claims to the tune of over $1 billion annually -- that's money that physicians could  have collected based on their documentation, but forfeited because they reported a lower-level code than they should have. But remember that your responsibility as someone who submits claims to Medicare is to code based on the documentation -- anything else is incorrect coding. If your practice is downcoding claims, take note of the following reasons that you should code based on your documentation rather...

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