E/M Coding: Incorrect E/M Coding Is A $6.7 Billion Per Year Problem, OIG Says

Why This Topic Matters

The article highlights why E/M coding remains a high-scrutiny area for payers and why documentation quality can affect compliance and reimbursement risk.

Article Sections

1. Overview of the OIG report

   Introduces the report’s findings about E/M coding accuracy and the scale of improper payments identified in Medicare claims. It also frames why the issue matters to audit activity and payer scrutiny.

2. Upcoded claims

   Discusses one major category of E/M claim error and the associated documentation concerns. The section also notes the role of supporting the selected level of service.

3. Downcoded claims

   Addresses claims that were reported at a lower level than supported by the record. It emphasizes the impact of underreporting on reimbursement and documentation practices.

4. Insufficient documentation

   Reviews situations where documentation was incomplete, illegible, or lacked necessary elements. The section explains how these shortcomings affect claim review outcomes.

5. No documentation

   Covers claims that were treated as lacking documentation in response to a request. It highlights the importance of submitting complete records when asked.

6. Billing the wrong code

   Describes claims that involved using an inappropriate code for the service documented. The section also touches on broader coding and bundling concerns.