Healthicity Blog

For this episode of Compliance Conversations, I sat down with Chad Peterson, a senior consultant at a large hospital, in their professional coding and reimbursement group. He educates physicians, mid-level providers/ advanced practice providers and even ancillary staff about E/M coding.

Compliance officers don’t necessarily need to know everything about medical coding and modifiers, but at a minimum, compliance officers should know that modifiers matter.

It can be a total nightmare to figure out the definition of a “detailed” examination using 1995 Documentation Guidelines for Evaluation and Management Services. It doesn’t help that CMS has been reluctant to expand the definition. It’s frustrating, isn’t it?

“Use your words,” my mom used to say. And, as with most things, she was right. Words are important.

Many of you posted some great questions during our webinar, The Five Problem Areas in E/M Audits. Unfortunately, we weren’t able to get to all of them.

Evaluation and management (E/M) services are “visits performed by doctors to assess and manage a beneficiary's health,” according to the OIG’s website.

Getting the most out of an E/M audit can be as simple as paying extra attention to common coding and documentation errors, common exam mistakes, and Medical Decision Making (MDM) mistakes.

Every healthcare organization is faced with the challenge of improving their auditing efforts to meet compliance requirements. Arming yourself with the right information can vastly improve the way your organization approaches Evaluation & Management Audits (E/M) audits.