Medical coding problems arise in part when they result in payers spotting abnormalities in the claims information. This prompts an audit and discovery of overpayments, and the payer then takes steps to get that money returned. The provider suffers because they’ve used that money for payroll or equipment, and now their cash flow is disrupted. Repeated instances of such recoupments can result in significant dollar drain and additional future reimbursement scrutiny. 

Here are some evaluation and management (E/M) coding tips from Medical Economics for preventing such claim disputes and recoupments:

• Tie the patient encounter to the right E/M code. If a patient case requires medication management, referrals, or more intensive steps, then it will justify certain codes that are not applicable to other more straightforward instances.
• Check the E/M guidelines for specific instructions for billing based on medical decision-making, history, and exam. Understand the common mistakes that are made for certain levels of E/M coding and how to rectify those errors going forward.
• Be careful using “copy and paste.” While your staff might save time by bringing in past information from a previous patient encounter, they’re asking for trouble. It’s all about relevancy. Ask if the coding is right for the current patient encounter.
• Avoid using pre-populated EMR templates that can raise red flags. Some of these templates always show certain patient systems are checked by default, but did that occur in the actual encounter? Pre-populated templates make it harder to line up the actual diagnosis with the coding.

Figuring out the type of billing for E/M services is important. When the doctor meets with a patient face-to-face then time-based billing is the proper route. If the care is provided via phone or email, then that type of billing is not appropriate. Medical Economics provides some other tips to ensure proper coding for this time-based billing:

• Understand the time that is associated with the E/M level and carefully log that time.
• Carefully document the time spent with the patient face-to-face and the time used for counseling and the coordination of care.
• Take notes regarding the type of care/counsel provided, noting that this does not mean including time spent on the back-end with documentation, discussions with other healthcare professionals, and other non-patient-focused activities.

Aviacode’s medical coding services can help your practice avoid E/M medical coding, as well as CPT, DRG, and HCC coding. Aviacode has over 700 coders, all certified by AAPC or AHIMA, that understand how to code each specific encounter accurately and completely. Our team of experienced medical coders accurately code more than 10 million encounters per year, helping providers avoid costly mistakes and improve their revenue integrity.