Comparing Coding

May 1, 2004

We have been using your E&M Coding Calculator on your web site to compare our coding patterns to the CMS averages. Is it appropriate for us to use our coding patterns for our entire patient population, or should we only include Medicare and Medicaid patients?

Question: We have been using your E&M Coding Calculator on your web site to compare our coding patterns to the CMS averages. Is it appropriate for us to use our coding patterns for our entire patient population, or should we only include Medicare and Medicaid patients?

Answer: The data on our calculator is from CMS and only reflects Medicare coding.

If the physician(s) believe that their coding patterns are different based on payer, then there are grounds NOT to use this data on an entire population. You could always run a quick internal check on your own data - E&M patterns, for, let's say, the 99211-99215 series for "Cardiology-MCR" and "Cardiology-all others." If you see statistically significant differences in the charts, there is reason to believe that benchmarking against this data wouldn't be advisable.

Of course, the key to coding is that you are coding according to the services that you provided and the documentation that you have of them. Coding comparisons aside, your best bet is to make sure that you can defend your coding patterns with your documentation. If you can, there is no need to worry about a variance from Medicare's normative data.