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May 29, 2012

Coding Trends of Medicare Evaluation and Management Services

In May 2012, the Department of Health and Human Services Office of Inspector General (OIG) issued a report entitled “Coding Trends of Medicare Evaluation and Management Services.” This study was conducted because between 2001 and 2010, Medicare payments for Part B goods and services increased by 43 percent, from $77 billion to $110 billion. During this same time, Medicare payments for evaluation and management (E/M) services increased by 48 percent, from $22.7 billion to $33.5 billion.

What did the Study find? From 2001 to 2010, physicians increased their billing of higher level E/M codes in all types of E/M services. Among these physicians, the OIG identified approximately 1,700 who consistently billed higher level E/M codes in 2010. Although these physicians differed from others in their billing of E/M codes, they practiced in nearly all States and represented similar specialties. The physicians who consistently billed higher level E/M codes also treated beneficiaries of similar ages and with similar diagnoses as those treated by other physicians.

CMS will conduct additional reviews of physicians who consistently bill higher level E/M codes to ensure that their claims are appropriate. If CMS determines that inappropriate claims have been paid, it will take steps to recover those overpayments. So my advice is to look closely at your physician practice's E/M patterns; if you think there might be an overcoding issue, have a sample of charts reviewed by an independent coding consultant to ensure the medical record documentation supports the level of E/M service billed.


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