Medicare Compliance & Reimbursement - 2013 Issue 10
Reader Question: Not All Follow-ups Are Created Equal
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Article Overview
This reader Q&A discusses evaluation and management coding for office visits, with emphasis on established-patient follow-ups and low-level versus higher-level service selection. It is aimed at coders, billers, auditors, and physicians who want to understand how documentation and medical necessity affect E/M level determination in routine follow-up scenarios. The article addresses common misconceptions about choosing a code based only on whether a problem is new or a visit is a follow-up, and it highlights the need to evaluate each case individually.
Why This Topic Matters
Misunderstanding how to choose an E/M level can lead to undercoding or overcoding, both of which can affect compliance and reimbursement. This article helps readers recognize that visit classification depends on the record, not just the complaint or follow-up status.
What You Will Learn
- How E/M level selection is generally tied to documentation and medical necessity
- Why follow-up status alone does not determine office visit level
- How low-level and higher-level established-patient visits are discussed in audit contexts
- Why individualized coding review matters when symptoms, history, and coexisting conditions vary
Who Should Read This
- Medical coders
- Medical billers
- Physician office staff
- Compliance auditors
- Healthcare providers
Codes Discussed
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