One of the most common reasons for an insurance audit is up-coding of E/M visits. Physicians think that by examining any number of systems in their examination, they automatically “get credit” for examining that number of systems in figuring out which level E/M code to bill. You do not automatically get credit for any particular number of systems examined unless that system is conceivably relevant to establishing your diagnosis. An example would be a topical Candida infection might not warrant examining 10 systems. Having your billing done by a certified coder would be very helpful in avoiding such situations. Until next week,
Larry Kobak, Esq.