EM Coding Alert

Solidify hospital coding by using pre-payment audit results.

NGS Medicare’s recent revelation about its 65 percent error rate for code 99215 seems astronomical, but it’s actually a much better result than the payer’s review of hospital E/M codes 99223 (Initial hospital care…) and 99233 (Subsequent hospital care…).

Both hospital E/M codes had error rates above 70 percent during October, November, and December of 2015. Most of the claims were missing documentation that would have supported the code levels, while others were denied due to illegible documentation, failure to send medical records, documentation missing the beneficiary’s identification, duplicate services, and a different rendering physician billing the claim versus whose name was on the documentation.

NGS also revealed its pre-payment audit results for prolonged service codes 99354-99357, chiropractic codes 98940-98941, and vascular diagnostic studies and osteopathic manipulative therapy, among others. Visit www.ngsmedicare.com for more information.