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tci Part B Insider - 2005 Issue 2
What's One E/M Level Between Auditors?
When a physician upcodes or downcodes an evaluation and management claim, most of the time it's only by one level. That should be considered a matter of professional judgment, because even Centers for Medicare & Medicaid Services officials can't always agree on the correct E/M level for a particular visit, says a spokesperson from the American Medical Association.
In its most recent House of Delegates meeting, the AMA urged CMS to give physicians relief from fraud and abuse witch-hunts. The AMA suggested that if a physician is only one level off the correct E/M level, this shouldn't count as...
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Keep pace with evolving Medicare regulations with timely analysis of critical updates interpreted in an easy-to-follow, easy-to-apply format. Your subscription to TCI’s Part B Insider will equip you to navigate code and guideline changes, CCI edits, and revisions to modifiers, the fee schedule, OIG target areas, and more.
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