• E & M Service Coding and Audit Worksheet

    Clear, complete, and concise medical documentation is critical to providing patients with high quality and safe medical care. Medical documentation is also essential for accurate and timely payment for healthcare services. Qualifying for payment requires skillful application of the documentation guidelines for evaluation and management services published by the Center

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  • Emergency Department Downcoding Rate

    What is Downcoding? Downcoding occurs when an insurer decreases the E&M service level to a lower code, resulting in lower payment for the service delivered.  For example, submitting a charge for a level 5 emergency department visit (99285, the highest level) for “allergic rhinitis” is likely to be downcoded. What

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  • The official 1995 E&M Guidelines from CMS

    Download the 1995 E&M Guidelines as a PDF

    What are E&M Services? Not all medical services are covered under the 1995 E&M Guidelines. Surgeries, lab tests, preventative medicine, counseling, and imaging studies have separate documentation rules. What are the differences between the 1995 and 1997 E&M Guidelines? The 1995 E&M Guidelines issued by CMS were the first medical

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  • E&M Coding Accuracy – Family Practice Clinic

    Why is E&M Coding Accuracy important? For most medical practices, E&M services represent the bulk of their charges.  Accurate coding ensures that you are paid for the medical services you actually provide and reduces your RAC audit risk.    The data was extracted from 429 clinic notes from a family medicine

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  • Official Trailblazer E&M Audit Tool as a PDF

    Download the official Trailblazer E&M Worksheet as a PDF

    Medical Decision Making (MDM) with the Trailblazer E&M Audit Tool Quantifying medical decision making for E&M coding is only partly outlined in the 1997 Guidelines for E&M Services. The exact methods to quantify the number of diagnostic/treatment options and the data reviewed is not clearly defined in these Guidelines. To

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