Wiki Selecting E/M level based on presenting problem

[maine4me]

I am currently in the middle of audits for our family practice physicians, and have come across a commonality in the way the physicians code E/M visits. They base the code on the presenting problem, which I know helps them to establish medical necessity, but they have the code they will bill in mind before they complete the visit and documentation. What I am seeing in the audit is that they can usually bill a higher code, and not by a slim margin. How do I help the doctors learn to choose codes based on the entire visit, and not just the problem the patient presents with? Has anyone had this issue and how did you resolve it?

 

[Peter Davidyock]

I would suggest starting by showing them a break down of what you have discovered.
They may not understand how to score E/M.
Then show them the money. The money they have lost by undercoding.