Payers typically deny evaluation and management codes on the back end of the billing process, which can cause costly reimbursement recoupments, according to Medical Economics.
Four tips to avoid denials caused by inaccurate E/M levels:
1. Make sure the E/M code supports the specific patient encounter.
2. Consult the 1995 or 1997 E/M guidelines, which specify requirements for time-based billing and billing based on history, exam and medical decision-making.
3. Validate any information that was copied and pasted to ensure it's relevant to the current encounter.
4. Ensure documentation aligns with the patient's diagnosis by changing pre-populated fields in EHR templates.