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Medicare's E&M codes by speciality
Question: I have seen you publish coding "profile" information and I want to get some normal profile information for my docs. Is there any way I can get the recommended established E&M code distribution for OB/GYN?
Answer: What I have referenced in the past is from the CMS.gov website. Look under Research, Statistics and Data, then Medicare Fee for Service Statistics for Parts A & B, then Medicare Utilization for Part B, then E&M code by specialty. Remember the Obstetrics/Gynecology curve reflected here is all Medicare data - so it is mostly GYN. This also does not include commercial payer data. Remember that when you are looking at this. It's the latest we have from Medicare, as of fiscal 2008.
Also remember that this is not recommended in any way, it is what is reported by physicians - likely with a good bit of undercoding in there. But it is what Medicare compares you to.
Bill Dacey, CPC, MBA, MHA, is principal in the Dacey Group, a consulting firm dedicated to coding, billing, documentation, and compliance concerns. Dacey is a PMCC-certified instructor and has been active in physician training for more than 20 years. He can be reached at firstname.lastname@example.org or email@example.com.
This question originally appeared in the September 2010 issue of Physicians Practice.