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October 2010
Clinical Practice Management
E&M Service Codes Face Higher Scrutiny, Some Claims Delayed

ID practices should make sure their documentation for Evaluation and Management (E&M) service codes is in order or risk having some of their Medicare claims delayed.

A Medicare contractor handling claims for Delaware, Maryland, New Jersey, Pennsylvania, Washington, D.C., and Northern Virginia recently began targeting services billed under codes 99204 and 99205 for additional review, according to a recent article in Part B News. The contractor cited increasing error rates as specialists are now using these codes instead of the consultation codes the Centers for Medicare and Medicaid (CMS) stopped reimbursing for starting Jan. 1, 2010. IDSA and many other internal medicine subspecialties opposed and continue to work to reverse this CMS decision. The article noted the additional scrutiny for high-level E&M service codes could spread to other Medicare jurisdictions around the country.

For more information about E&M coding, codes used by ID physicians, and how an auditor looks at your codes, check out the presentations from the Billing and Coding Workshop held at the 48th Annual Meeting of IDSA earlier this month. Audio and synchronized speaker slides from the workshop are available for purchase online.

Billing and coding resources for IDSA members are also available on the Society’s website. Visit the Billing and Coding Resources page of the IDSA website. (You must be logged in to access this page.)
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