• L Manchikanti.
• Pain Management Center of Paducah, 2831 Lone Oak Road, Paducah, KY 42003, USA. drm@apex.net
• Pain Physician. 2000 Jul 1;3(3):322-41.

AbstractProper coding and documentation for evaluation and management services continuously and progressively are becoming not only complicated, but also confusing. Although medical evaluation of patients has been a fact of life since the beginnings of medical history, medicine has been substantially influenced by federal regulations since the enactment of Medicare. Physicians' fear of being prosecuted is increasing. This is reinforced by actions of the federal government in multiple cases with sky-high penalties and by the Office of the Inspector General's target of 600,000 physicians in practice in its work plan for the new millennium. Evaluation and management services utilization, medical necessity, and appropriate documentation for level and complexity of service are extremely important components of evaluation and management services. Similarly, differentiating between a consult versus a visit is also crucial to avoid upcoding, or in a worst-case scenario, downcoding. While the history is the same for all types of visits except for the complexity for each level, four types of physical examination are available, either in a general multisystem examination or a single-system examination. However, the complexity of medical decision making is the essential factor in deciding to which level the evaluation and management belong. This review will discuss various aspects of evaluation and management guidelines in interventional practice and also guide the physician in performing these evaluations in an appropriate manner with proper documentation, thus avoiding the pitfalls of fraud and abuse.

12 keywords...

hide…