e.g., office consultation. third, the content of the service is defined, e.g., comprehensive history and comprehensive examination. fourth, the nature of the presenting problem(s) usually associated with a given level is described. fifth, the time typically required to provide the service is specified. the levels of e/m services include examinations, evaluations, treatments, conferences with or concerning patients, preventive pediatric and adult health supervision, and similar medical services, such as the determination of the need and/or location for appropriate care. the levels of e/m services encompass the wide variations in skill, effort, time, responsibility, and medical knowledge required for the prevention or diagnosis and treatment of illness or injury and the promotion of optimal health. according to the center for Public integrity,2 physicians are expected to bill a range of e/m levels for established patient visits (codes 99211-99215), since some patients require more resources than others. the increase in the use of high-level e/m codes could be a result of providers deliberately inflating their bills. alternatively, it could simply be a result of the CODING corner complexity and vagueness of the coding system. the concern is that some physicians may be intentionally upcoding, practicing “code creep” or “coding inflation,” all defined as forms of charge enhancement where physicians charge patients for more expensive services than were actually performed. according to a recent article in the Washington Post,3 the transition to electronic medical records, which make it possible to create detailed patient files with just a few mouse clicks, is likely contributing to the shift in code utilization. electronic health record (ehr) software enables providers to quickly create a comprehensive encounter record. the Washington Post article cites as an example an ehr vendor who predicts that “its product will result in an increase of one coding level for each patient visit, potentially adding $225,000 in new revenue in a year.” a recent report from the office of inspector general found that 57 percent of medicare physicians use an electronic health record and 90 percent of them use their systems to document e/m services. in a related issue, most medicare physicians report the e/m code manually and don’t allow the electronic medical record to determine the code level, when the software provides this feature.4 connolly, inc., the ra for 15 states and two u.s. territories, is the journal of the healthcare billing and management association 43
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