New approach aims to educate and promote appropriate use of evaluation and management codes

Selecting the CPT code that best reflects the complexity of an evaluation and management service is a big challenge for coders. Perhaps that’s why there are more mistakes made with E/M coding than with coding for other services.

To help health care providers and their office staff determine which E/M code appropriately reflects the complexity of a visit, Blue Cross Blue Shield of Michigan has contracted with Change Healthcare to implement its Coding Advisor solution. Change Healthcare reviews the E/M codes billed and other scenarios, such as modifier 25, observation care and nursing facility care, on claims submitted to Blue Cross. The program provides useful data insights to the provider community and works to maximize coding efficiency and accuracy through up-front education, rather than a traditional post-claim review process.

Beginning in the first quarter of 2019, Change Healthcare will reach out by phone or letter to a subset of providers who submit claims to Blue Cross with E/M codes. Coding Advisor will compare the billing of those codes across provider types with their peers through a physician profile. See example of a physician profile below.

Throughout the course of this program, Coding Advisor will continue to monitor billing practices and send updated reports periodically. They may contact your practice to discuss coding variances and to offer one-on-one coding education. All correspondence will be sent to you from Change Healthcare.

If you have any questions, call Change Healthcare Customer Support at 1-844-592-7009, Option 3.

None of the information included in this article is intended to be legal advice and, as such, it remains the health care provider’s responsibility to ensure that all coding and documentation are done in accordance with all applicable state and federal laws and regulations.