E/M Coding: Master E/M Claims with Advice From Part B MACs

Why This Topic Matters

E/M claims are often judged against documentation standards that vary in interpretation across payers and auditors. Understanding the kinds of guidance MACs publish can help practices better align documentation workflows with review expectations.

Article Sections

1. Tip 1: Procedural Services Count Toward "New Patient" Rules

   Explains how the article addresses patient status questions when prior face-to-face services, diagnostic test interpretation, or non-physician practitioner involvement are part of the history. It also references guidance shared by a Medicare Part B MAC.

2. Tip 2: Switching Practices Doesn't Change Status from 'Established' to 'New'

   Discusses how patient status may carry over when a physician moves to a new group practice. The section focuses on group practice and specialty considerations in the context of E/M billing.

3. Tip 3: You May Be Defining 'Double Dipping' Improperly

   Covers documentation of history elements and how overlapping documentation may be viewed in E/M review. The section centers on common misconceptions about history-taking documentation.

4. Tip 4: Avoid The Blanket Statement 'Complete ROS Negative'

   Addresses review of systems and past, family, and social history documentation expectations. It highlights the general completeness of history elements used in E/M note review.

5. Tip 5: Know How Your MAC Calculates Physical Exams

   Summarizes the MAC’s general approach to scoring physical examination documentation under E/M guidance. It also references the 1995 and 1997 E/M guidelines and an example of an exam review method.