Mythbusters: Bust These E/M Coding Myths Once and for All

Why This Topic Matters

E/M coding remains one of the most error-prone areas in medical billing, and misunderstandings can affect code selection, compliance, and audit risk. This article helps readers identify where common assumptions may conflict with payer interpretation.

Article Sections

1. Introduction

   An overview of why E/M coding rules are often misunderstood and why MAC guidance is useful for clarification.

2. Myth 1: Surgical Visits Don't Count Toward "New Patient" Rules

   Discussion of how prior services and practice relationships can affect new versus established patient status, including related group-practice considerations.

3. Myth 2: Switching Practices Restarts the 3-Year Rule

   Clarification of how patient status may carry across practices and providers within the same specialty or group setting.

4. Myth 3: Thick Documentation Leads to a High-Level Code

   Explanation of why documentation volume alone is not the deciding factor in E/M level assignment and why medical necessity is central.

5. Myth 4: You Can't Count One Element Toward Both HPI and ROS

   A discussion of how documented history elements are sometimes considered across more than one portion of the E/M history.

6. Myth 5: Documenting "Abnormal" By Itself Is Sufficient in the Exam

   Coverage of exam documentation expectations and why additional support may be needed when findings are noted as abnormal.