Complying with prepayment requests for E/M documentation

• Carriers are continuing to review claims using both the 1994 and the 1997 versions of the documentation guidelines, “whichever is most advantageous to the physician,” according to HCFA's directive.

• The prepayment reviews are not limited to E/M office visit codes. Documentation for hospital E/M claims and others may also be requested.

Documentation checklists

Referrals from chiropractors

Scope of prolonged services codes

Fracture care in a nursing home

Editor's note: While this department represents our best efforts to provide accurate information and useful advice, we cannot guarantee that third-party payers will accept the coding and documentation recommended. For more detailed information refer to the current CPT manual and the “Documentation Guidelines for Evaluation and Management Services.”