A Letter from a Private Payor about my E & M Coding. Should I be Concerned?

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Question:

I received a letter from a private payor saying I report a higher percentage of 99204, 99205 and 99244 and 99245 than my peers. The letter advised me to review the E & M requirements for these codes. Should I be concerned?

Answer:

Yes you should! This is essentially a warning letter putting you on notice that if you continue to report a higher percentage of these high level codes than your peers, a payor audit will be the next step. You should immediately conduct an internal review of your E & M documentation to ensure that it supports the codes you report. I recommend a review of your E & M coding patterns compared to existing data from physicians of your same specialty. These data are available from the Medicare website. Alternatively, KZA can assist you with our E & M Analyzer, providing you with a comprehensive assessment of your E & M coding patterns as compared to your peers and where you might be at risk. Look for details on the KZA website. Be proactive and conduct an internal and external audit before your payor requests records and potential repayment!

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