SHOWING MEDICAL NECESSITY IN E/M CODING

PAYERS REDUCING E/M CODES

Be sure to verify that your diagnosis codes as well as your procedure codes reflect what you addressed during the visit. Payers’ automated downcoding programs may be based partially on presuming that certain diagnosis codes don’t support higher-level E/M codes. You could also consider auditing your code usage and comparing it to local and regional profiles, as some payers say that automatic downcoding is only used for “outlier” physicians.¹

SERVICES PROVIDED ON FEDERAL HOLIDAYS

COGNITIVE ASSESSMENT AND CARE PLAN ON SAME DATE AS E/M