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Capstone

Evaluation and management coding accuracy in primary care clinic

1 August 2002

Abstract

The business of medicine has changed substantially over the years, and all practitioners of medicine, physicians, physician assistants, and nurse practitioners, are being forced to play by a complex system of ever changing rules and regulations imposed on us by various entities. The Health Care Financing Administration, Medicare, Medicaid, and the multitude of other third party payers all require that practitioners now use a standardized, but complex, set of Current Procedural Terminology codes for billing our services. These CPT codes are designed to identify the nature of the patient encounter, the diagnosis, and the level of service provided by the practitioner. The Evaluation and Management codes, which indicate the level of service provided are often the scrutiny of auditors for third party payers, being reviewed for accuracy to determine whether the level of service is comparable to the diagnosis, and whether it is supported by the documentation. The providers of Legacy Clinic Good Samaritan were audited to determine the accuracy of their Evaluation and Management coding. Overall accuracy was found to be comparable to the national average revealed in a previous study.


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