You may be leaving money on the table by undercoding Evaluation & Management (E&M) services. Give me 10 minutes to help you untap a hidden revenue stream.
Medicare, Medicaid, and commercial payers collect utilization data when processing claims. Each has its own utilization data by specialty, and each payer uses specialty specific data to identify outliers who are overcoding. This data has another use, though, and that is for physicians to assess if they are undercoding relative to their peers. Therein lies an opportunity for you to potentially increase revenues.
Here’s my obligatory disclaimer: I am discussing coding and not documentation. Please make sure your documentation supports your coding levels.
OK. Let’s get to it. Medicare shares its E&M utilization data at the following link: Medicare E&M Code Utilization Tables. The file you need is CY 2016 Evaluation and Management (E&M) Codes by Specialty, which contains its most recent data, found near the bottom of the page. I am going to use Family Practice data from these tables in my example.
Editor's Note: Click here to download a worksheet author Lucien Roberts has prepared to help you identify potential undercoding, described in further detail below.
I created a simple spreadsheet, entering the E&M codes for new office patients and established office patients in my first column. I then entered the number of times each was used by Family Practice physicians in my second column.
Family Practice physicians used new patient codes 99201-99205 in billing Medicare 1,645,339 times in 2016. Established patient codes 99211-99215 were used 38,249,187 times. We can see for both that level 3 and level 4 codes are used more frequently.
I added a third column to the spreadsheet that converts the count in column two into a percentage. This is calculated by dividing the count for each new patient code by the count of total new patient codes and the count for each established patient code by the count of total established patient codes.
For example, we see that Family Practice physicians used the new patient code 99202 for 12.7 percent of their patients. We can also see 99213 is the code used for 42 percent of established patient visits.
This gives you great baseline data so you can see how often your peers use each E&M code.