Our state Medicare carrier (NHIC) has recently expressed concern that submitted E&M codes and associated charges may not be properly reflecting the work provided or that available documentation does not support the code level. I suspect the following article from them may foreshadow a new level of increased scrutiny and spot checks of our records. The CUA strongly believes that you should do all that is necessary and reasonable for your patients' health, code and bill for all you do and be paid fairly for all you bill. But, I'm telling you nothing new when I remind you that this requires that you fully document all your work to support those charges. The following article from NHIC is a reminder of those elements their auditors will use in reviewing your records. We highly recommend reviewing the elements of the various E&M code levels and keeping a copy handy to be sure your records are audit proof. As usual, please contact the CUA for any questions in this regard and let us know if your office is audited by any reviewer who challenges your coding or charges.

NHIC Medical Review Criteria l NHIC Evaluation & Management Coding Worksheet

Jeffrey Kaufman, MD, FACS

CUA representative to NHIC/Medicare Carrier Advisory Committee