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November 2016

We’ll monitor use of 2 frequently misused E&M codes

Blue Cross Blue Shield of Michigan will closely monitor the use of two evaluation and management procedure codes that are frequently misused — office visits *99214 and *99215.

A review of how these codes are used revealed they are often based on the stored patient history in electronic medical records rather than on the services that were actually rendered. This can result in a higher-level service being billed when a lower-level service is warranted, sometimes called upcoding.

To avoid clinical inquires about E&M services you provide, be sure to carefully document and code each service according to the national coding guidelines. The CMS Evaluation and Management Services Guide is a good resource for coding guidelines.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2015 American Medical Association. All rights reserved.
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