tci Part B Insider - 2005 Issue 2

What's One E/M Level Between Auditors?

When a physician upcodes or downcodes an evaluation and management claim, most of the time it's only by one level. That should be considered a matter of professional judgment, because even Centers for Medicare & Medicaid Services officials can't always agree on the correct E/M level for a particular visit, says a spokesperson from the American Medical Association. In its most recent House of Delegates meeting, the AMA urged CMS to give physicians relief from fraud and abuse witch-hunts. The AMA suggested that if a physician is only one level off the correct E/M level, this shouldn't count as...

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