tci Medicare Compliance & Reimbursement - 2009 Issue 9
E/M CODING: Check Your Answers to These 3 Q&As to Eliminate E/M Coding Confusion
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Article Overview
This article addresses common evaluation and management (E/M) coding questions raised by hospital and office-based scenarios. It is aimed at coders, billers, and compliance staff who need a clearer view of how payer policies, Medicare guidance, and documentation expectations affect E/M claims. The discussion centers on consultation billing in the hospital, shared visit documentation, and payer variation in reporting office visit code 99211.
Why This Topic Matters
E/M coding is a frequent source of claim errors and payer denials, so understanding the article’s scenarios can help readers assess whether the full discussion is relevant to their workflow and compliance needs.
Article Sections
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Avoid In-Hospital Incident-to's
Addresses a hospital-based consultation scenario involving an MLP and how inpatient billing is discussed in relation to E/M services.
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Scrutinize Shared Consults
Covers shared visit documentation in a consult setting, including the roles of the MLP, nurse, and physician.
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Check Payer Rules for 99211
Discusses payer variation and documentation considerations tied to office visit code 99211 in different visit contexts.
What You Will Learn
- How the article frames common E/M coding questions in hospital and office settings
- What types of documentation issues are raised for shared visits and consultations
- Why payer-specific policies can affect the reporting of office visit services
- Which general scenario types are discussed for code 99211 use
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Physician practice managers
- Clinic documentation staff
Codes Discussed
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