tci General Surgery Coding Alert - 2007 Issue 6

Learn Why It's Necessary to Demonstrate Medical Necessity

History and exam alone won't sustain your claim If you are a victim of the -E/M loophole- myth, you could be severely miscoding your E/M levels and collecting thousands more in payment than you deserve -- and that could lead to dire consequences down the line. MDM Matters Most, CMS Says The argument: Some physicians and coders reason that CPT guidelines allow reporting 99215 for an established patient based on a -comprehensive- history and a -comprehensive- examination, even if the medical decision-making (MDM) is low risk and there is no data to review. Therefore, the argument goes, you may...

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