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Evaluation & Management Distribution – How Does Your Practice Stack Up?

What this graph illustrates: The most commonly billed Current Procedural Terminology (CPT) codes come from the Evaluation and Management (E&M) section of the CPT manual. The graph below displays the distribution curves for the specialty of cardiology for the most utilized E&M codes, those being for New Patients (99201-99205) and Established Patients (99211-99215). The information was derived from both the 2008 CMS Evaluation and Management Codes by Specialty Study found at http://www.cms.gov/MedicareFeeforSvcPartsAB/04_MedicareUtilizationforPartB.asp and Navicure’s 2008 claim data from cardiology groups.

What this means to you: The proper coding of Evaluation and Management codes ensures protection for a practice from both a high compliance risk and lost revenues perspective. Utilizing comparative data sets, as shown on the graphs below, allows you to gauge where your practice falls on the risk spectrum (too high E&M levels = elevated risk of compliance audit) as well as how much revenue your practice is potentially leaving on the table (too low E&M levels = potential lost revenue). Note: Just because your practice falls inside or outside the guidance of these distribution curves does not mean that you practice is doing anything incorrectly. The bottom line is: Correctly code your E&Ms based on the examination, history and medical decision making components of the patient encounter and you will be fine.

(Click here to enlarge.)


(Click here to enlarge.)