Auditors watch out for coding compliance issues
Health Care Auditing Strategies, June 1, 2009
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Evaluation and management (E/M) codes describe the complexity of the professional services a provider renders during a visit. These codes represent office, hospital, and nursing home visits, as well as consultations and other nonprocedural services. You can locate the codes in your CPT Manual. There are currently two sets of E/M coding guidelines published jointly by CMS and the AMA:
- 1995 Documentation Guidelines for Evaluation and Management Services
- 1997 Documentation Guidelines for Evaluation and Management Services
Note: You may view both sets of guidelines on the CMS Web site at www.cms.hhs.gov/mlnedwebguide/ 25_emdoc.asp.
When considering these guidelines, note that the two major differences between the 1995 and 1997 guidelines are in how you code the history of the present illness and the exam elements. CMS allows providers to use either set of guidelines, depending on which is the most advantageous to the provider.
This is an excerpt from a member only article. To read the article in its entirety, please login.
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