The Medicare Recovery Audit Contractor (RAC) for our region, Connolly, Inc., has received permission from Centers for Medicare and Medicaid (CMS) to perform statistical sampling of physician Evaluation and Management (E&M) codes. This review may be performed on dates of service beginning Oct. 1, 2007.

The sampling follows a report by the Office of Inspector General that identified an increase in the use of higher E&M codes. Codes that were identified include New and Established Physician Office Visits, Emergency Room Visits, Initial and Subsequent Nursing Facility Visits and Initial and Subsequent Hospital Care Visits. States in the Southeast region ranked high among all states with high numbers of physicians, who utilized the higher codes with state rankings as follows: Florida #3, Georgia #12, Tennessee #15, Alabama #20 and Mississippi # 27.

Over‐coding can result in an organization being paid more than is supported by documentation in the patient record. Deficient documentation may be due to lack of understanding of coding rules and/or a failure to fully document the patient’s examination and treatment. Over‐coding can also occur in an electronic health record (EHR) environment where “cut and paste” information is used from one patient’s record into another patient’s record, or by use of auto‐ filling a record using default check boxes that result in documentation of exam components not actually performed. Organizations that bill for professional fees should be aware of the RAC activities in this area. If needed, Warren Averett can provide assistance in reviewing E&M coding profiles and documentation used to support E&M coding levels. We can also provide education and training in E&M coding and documentation.

For more information, please contact Tammie Lunceford at 205.769.3262