Part B Insider - 2014 Issue 1
Reader Question: Don't Pigeon Hole E/M Services
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Article Overview
This article addresses a surgeon’s assumption that certain follow-up visits should always map to the lowest established-patient E/M levels while other visits should automatically be billed higher. It explains, at a high level, why the article matters for coders, auditors, and physicians who review evaluation and management documentation, and it focuses on general principles for selecting visit levels from the record rather than from a preset rule.
Why This Topic Matters
It helps readers recognize that E/M coding decisions should be supported by the documented service and the patient’s overall situation, which is important for accurate reporting and internal audit consistency.
What You Will Learn
- How E/M level selection is evaluated from documentation and medical necessity
- Why visit type alone should not determine the reported service level
- How internal audit findings can prompt review of established-patient coding practices
- What kinds of documentation patterns may support different E/M levels in general
Who Should Read This
- Physicians
- Surgeons
- Medical coders
- Coding auditors
- Billing staff
- Practice managers
Codes Discussed
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