If you want to hear creative cursing, ask almost any physician what he (she) thinks of E&M coding. One cannot imagine a more Byzantine method for determing physician reimbursement. Only a truly confused bureucrat – or worse a committee of the confused – could have developed this system. Because the government determines payments using this system, I have to go to classes to learn it. The lecturer always starts saying that it is actually simple – and I zone out. That lecturer has started with a lie, and I cannot believe anything else said.

I am right!!! Study confirms: Even experts confused by Medicare coding: Specialized coding agencies can’t agree on proper E&M codes. The system is indecipherable. The fundamental flaw is to link documentation to reimbursement. We have inflated charts – inflated with ‘fluff’ for billing purposes. Our charts should speak to the patient’s problems and reflect our thinking and plans. Rather we document long histories, review of systems, social histories, and physical exams – on each and every visit!

A new study bolsters what many physicians have claimed for years — Medicare’s evaluation and management coding process is horribly confusing.

Researchers from the Dept. of Emergency Medicine at the William Beaumont Hospital System in Royal Oak, Mich., set out to determine how well even experts could do in appropriately coding emergency department visits.

The study, published in the September issue of Annals of Emergency Medicine, looked at the five E&M codes that represent 70% of the codes emergency physicians use to bill for their services.

The researchers, led by Raymond Jackson, MD, sent copies of 389 medical records to four private coding firms and asked them to correctly assign codes to the emergency department visits documented in the charts. They found little consensus.

The agencies agreed on the proper coding in only 15% of the charts. In 6%, the four coding firms came up with four different codes. And in 29% of the records, the coders disagreed by more than two code levels.

The study also compared the coding decisions made by four coders within the same coding agency. The results were only slightly better.

Bravo !!!! Sometimes a study needs to be done. If one could sue the federal government, physicians would have a great case here. Think of the mental anguish we have suffered. Wait! We would have to work with lawyers on a contingency basis. I prefer that we just have E&M abolished. I can forgive and forget. But Congress should restore penalities leveled against those charged with fraud on the basis of E&M problems.

For physicians, the coding morass is more than just an issue of frustration. Because E&M codes account for about $18 billion in Medicare payments each year, investigators from the Dept. of Health and Human Services’ Office of the Inspector General have been focusing on improper use of E&M coding in their antifraud efforts.

The hospital’s study seems to support physicians’ claims that many cases of improper coding result from the confusion surrounding E&M codes, rather than an effort to defraud the government.

“The truth is that most of what the government calls fraud and abuse results from simple billing errors and the problems inherent in complying with Medicare’s more than 100,000 pages of rules and supporting documents,” said Michael Carius, MD, president of the American College of Emergency Physicians.

According to Brent Asplin, MD, an emergency physician from the Regions Hospital and HealthPartners Research Foundation in St. Paul, Minn., the study shows that E&M coding methods are not reliable enough to be the basis for antifraud efforts.

“This study is similar to the famous tax test that Money magazine conducted a couple of years ago,” Dr. Asplin said. “Money sent a hypothetical family’s tax return to 46 different tax preparers and got back 46 different answers. Dr. Jackson’s team finds that the Medicare coding system is just as prone to inconsistency and disagreement, even when specialists are put to the task.”

This study is VERY important. We need to have this problem fixed – and quickly. I am certain the AMA will work towards that end. I hope that all rational politicians (oops another oxymoron) will end this nightmare with swift legislation.

Related posts:

1. Tired of emails about coding classes
2. Shortened visits – more on the suits
3. Please change our coding and reimbursement system!!!!!!
4. A letter to Gruntdoc on ER admission
5. Primary care payment – is win-win possible?

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