The medical decision-making (MDM) component of evaluation and management (E/M) services is perhaps the most crucial element in determining the correct level of service assignment for patient encounters. The majority of individuals involved in the E/M coding process may not agree on the interpretation of the components, but would agree that the clinical thought process ...
Healthcare expenditures account for an estimated 18 percent of the United States’ gross domestic product. A 2014 BMC Health Services Research study (“Billing and Insurance-related Administrative Costs in United States’ Health Care”) found that in 2012 billing and insurance-related administrative costs alone totaled $471 billion — nearly one-fifth of all healthcare costs. While I celebrate ...
Apr 1st, 2015
Ignoring how medical decision-making affects E/M leveling can put you at risk. By Ellen Risotti-Hinkle, CPC, CPC-I, CPMA, CEMC, CIMC, CFPC When coding evaluation and management (E/M) services, it’s crucial to take into account medical necessity. Services billed at a level higher than what the medical necessity warrants will result in take-backs in the event ...
In Billing
May 11th, 2012
The U.S. Department of Health & Human Services (HHS) Office of Inspector General (OIG) says that physicians are reporting high-level evaluation and management (E/M) codes more frequently for all types of E/M services. Medicare payments for E/M services increased 48 percent in the decade ending 2010, from $22.7 billion to $33.5 billion. Overall, Medicare payments for ...
Jan 1st, 2011
By Jim Strafford, CEDC, MCS-P How well does your emergency department (ED) assign evaluation and management (E/M) levels based on the resources used? How does your facility compare to other, similar facilities? If you don’t know the answers, it’s time to take a closer look at your facility E/M leveling. Review Guidelines The Centers for ...