News: Thorough documentation required for E/M billing, CMS reminds providers
October 6, 2016
CDI Strategies - Volume 10, Issue 42
Physicians often ask why documentation matters to them. Last week, CMS sent out a reminder regarding the importance of complete and accurate documentation related to physician evaluation and management (E/M) codes.
In a 2012 study report, the Office of the Inspector General (OIG) noted that a number of physicians increased their billing of higher level, more complex and expensive E/M codes. Many providers submit claims coded at a higher or lower level than the medical record documentation supports. The following resources can be used to bill correctly for E/M services:
- OIG Report: Coding Trends of Medicare E/M Services
- Medicare Claims Processing Manual: Chapter 12, Section 30.6
- E/M Services Guide
- 1995 Documentation Guidelines for E/M Services
- 1997 Documentation Guidelines for E/M Services
- Frequently Asked Question on Use of 1995 and 1997 Guidelines
CDI specialists should review the requirements and guidance to prepare themselves when providers come to them and ask for help.