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tci Medicare Compliance & Reimbursement - 2010 Issue 9

E/M Coding: Don't Bill High-Level E/M Codes Until You Read This

Sicker patients may not always mean higher MDM. If your physician bills a lot of high-level office visits, he may be at risk of an audit -- which may not be cause for concern -- if his documentation justifies his code choices. "Some physicians believe their patients are sicker than others', so they feel they're justified using more 99215s, when in fact that may not be the case," says Crystal S. Reeves, CPC, CPC-H, consultant with Coker Group in Alpharetta, Ga. "The CPT manual outlines the requirements of the E/M codes, there are clinical examples in the back...

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