Office visits represent a huge proportion of revenue for many practice types. Consistently accurate coding of office visits is important to avoid costly under-coding or inadvertently coding above the level that applies, which could lead to revenue take-backs.
Since the E/M range constitutes such a huge piece of the overall reimbursement pie, payers are very concerned about accurate coding, too. That’s why E/M coding can be a trigger for a payer audit if your practice’s utilization appears unusual.
One way to check your office visit coding patterns to see how they conform to other practices in your specialty is to compare your utilization of each code to published CMS data. If you find that your clinicians’ coding diverges noticeably from national data, and the reasons aren’t immediately clear, it could be time for a closer review or internal chart audit.
Besides comparing against the CMS numbers, you can compare your clinicians’ numbers against each other. In our consulting, we often find that physicians in the same practice will gradually skew in different directions (some coding a little higher than the average, some a little lower) over time.
Sometimes, differences in utilization make perfect sense — such as when the doctors see distinctly different patient populations. But not always. If the variances don’t look logical to you, it’s time to take a closer look. You may find it’s time to bring in an E/M coding expert for a customized refresher course and/or chart audit. (If you need this help, we can refer you to excellent resources. Just contact us.)
Getting your hands on the CMS data, then entering it into a spreadsheet, can be a bit time-consuming — but we’ve taken care of some of the drudgery for you!
Follow the links below to download a spreadsheet that already has the CMS data keyed, plus is set up with formulas to calculate your clinicians’ or your practice’s utilization of each code, and compare it with the national averages.
Allergy and immunology
Need a different specialty? Contact us and we’ll pull it together for you, provided the CMS has published data for it.
For more ideas on analyzing your E/M code data, or just a bit more detail on why this analysis is so important, check out this other recent article I wrote on the subject for Magellan Diagnostics’ site.