tci Part B Insider - 2005 Issue 36

Part B Coding Coach: Put The Brakes On High-Level E/M Fraud

A hospital admission waiting to happen may be a green light to 99215 You know the Office of Inspector General watches evaluation and management (E/M) coding carefully, hunting down incorrect claims and overpayments. If you want to keep the auditors off your back, we’ve got the information you need about when you should--and shouldn’t--report high level E/M codes. Key In On Medical Necessity When determining a visit’s history--problem-focused, expanded problem-focused, detailed or comprehensive--the type of history must be medically necessary based on the encounter. “The extent of the history is dependent upon clinical judgment and...

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