Results 1 to 3 of 3

E&M % Ratio

  1. Default E&M % Ratio
    Medical Coding Books
    I will appreciate some feedback on % ratio of E&M levels providers billed deem reasonable. My facility has two orthopaedics doctors, upon my review of their documentation I am justifying for E&M 99204 and E&M 99244 (levels 4) for most maybe 95% or more of their new patients.
    Their MDM are as follows:
    1.Pain, new problem to provider, provider ordering X-ray or MRI to r/o ?????
    2.Pain, new problem to provider, provider given Rx for pain meds.
    3.Pain, new problem to provider, provider given Rx for pain meds & ordering X-ray or MRI .
    Note; Physical therapy may also are added to the above MDM

    History = Comprehensive (4 or more HPI Element, 3 PFSH, 10 ROS system)
    Exam = Comprehensive (8 organ systems)

    Thank you in advance for responding.

  2. Default

    I don't know anything about what is normal for that specialty, but I use the above tool to compare our percentages to others.

    Your Medicare contractor may also have a tool online which allows you to compare your E/M codes to others in your region. You may want to call them.

    April Sue

  3. #3
    I would be looking into having a clinical review for medical necessity with those numbers. Not that I agree with the bell curves but why is it medically necessary for an orthopedic provider to do a comprehensive history and exam on pretty much every new patient and they aren't even planning to do surgery?

    I have had quite a few orthopedic providers tell me they will never get above a 3 for a new patient because it is not medically necessary for them to do the comprehensive history and exam even though they may have Moderate or High MDM.

    It may be totally correct and on the up and up but I would want someone clinical to review for the medical necessity piece just to be sure.

    There are those that teach to work backwards from MDM and perform the levels of history and exam based on your MDM level. As we all know medical necessity should be the driving factor. MDM and medical necessity are not the same thing.

    Just my 2 cents,

    Laura, CPC, CPMA, CPC-I, CEMC

Similar Threads

  1. MD to Coder Ratio
    By JennW1211 in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 09-17-2014, 12:06 PM
  2. Collection Ratio's
    By Nadkins in forum General Discussion
    Replies: 0
    Last Post: 03-15-2012, 01:20 PM
  3. negetive S D ratio
    By srinivas r sajja in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 05-15-2009, 06:40 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.