Medicare Compliance & Reimbursement - 2013 Issue 45
Reader Question: Watch For Coding Trends
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Article Overview
This article discusses a reader question about common habits in selecting office/outpatient evaluation and management levels for established patients. It explains the broader documentation and medical necessity factors that influence level selection, why one-size-fits-all coding habits can create risk, and how clinicians and coders should think about varying encounter complexity in general terms. The piece is intended for coding staff, auditors, and physicians involved in E/M documentation review and compliance.
Why This Topic Matters
It helps readers recognize that outpatient E/M coding should reflect the documented service and clinical necessity, supporting more accurate auditing, education, and compliance.
What You Will Learn
- How outpatient E/M level selection is generally tied to documentation and medical necessity.
- Why coding based on patient type or visit pattern alone can be problematic.
- How broader clinical context and documented management can affect service level selection.
- What internal audits may reveal about recurring coding habits.
Who Should Read This
- Medical coders
- Coding auditors
- Physicians
- Practice managers
- Compliance staff
Codes Discussed
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