Outpatient Facility Coding Alert - 2016 Issue 9
Reader Question: Educate Physicians on 'Automatic' E/M Coding
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Article Overview
This reader Q&A discusses physician education around hospital inpatient subsequent visit evaluation and management coding, with emphasis on avoiding assumption-based code selection. It is aimed at coders, auditors, coding directors, and physician educators who need a clear understanding of how documentation supports service levels and why payer scrutiny may increase when coding patterns appear repetitive or atypical. The article covers general E/M level selection concepts, documentation support, and the risk of outlier utilization patterns without giving a substitute for the premium coding guidance.
Why This Topic Matters
Misunderstanding how to select E/M levels can lead to inconsistent coding patterns, compliance risk, and payer concerns. The article helps readers recognize why service level selection must be grounded in the documented encounter rather than the patient’s diagnosis alone.
What You Will Learn
- Why diagnosis alone does not determine an inpatient subsequent visit E/M level
- How documentation supports selection of the reported service level
- Why repetitive coding patterns may attract payer attention
- What general issues can arise when physicians assume a default E/M level
Who Should Read This
- Medical coders
- Coding auditors
- Compliance staff
- Physician educators
- Coding directors
- Cardiology practices
Codes Discussed
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