If you are like most physicians, you wonder not only whether you are selecting the right level of service when coding office visits but also whether your coding profile is similar to that of your peers. Benchmarks are not easy to come by, but specialty-specific evaluation and management (E/M) code data from the Centers for Medicare & Medicaid Services do make comparisons possible. The results of such comparisons should guide a more targeted review of your coding practices and resulting revenue-enhancement or risk-reduction strategies.
Office visit code distribution for Medicare
|New patient office visits||%||Established patient office visits||%|
Source: 2017 E/M Bell Curve & Auditing Sourcebook. Gaithersburg, MD: DecisionHealth; 2016.
Family physicians bill 81 percent of new patient visits as 99203s or 99204s and 91 percent of established patient visits as 99213s or 99214s. A physician with a lot of kids or young, healthy families in his or her panel may tend to report more lower-level codes, particularly as compared with the Medicare data shown here. Similarly, a physician whose panel is filled with patients who have multiple chronic problems or who are dually eligible for Medicare and Medicaid will probably report more higher-level codes than one whose schedule is filled primarily with acute visits.
— Betsy Nicoletti, a Massachusetts-based coding and billing consultant
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