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Part B Insider (Multispecialty) Coding Alert

Error Rates for Hospital E/M Codes Were Even Worse

Although the 65 percent error rate for code 99215 seems astronomical, the reality is that it’s a better result than NGS Medicare’s review of hospital E/M codes 99223 (Initial hospital care…) and 99233 (Subsequent hospital care…).

Both hospital E/M codes had error rates above 70 percent during October, November and December of 2015. Most of the claims were missing documentation that would have supported the code levels, while others were denied due to missing documentation, illegible documentation, failure to send medical records, documentation missing the beneficiary’s identification, duplicate services, and a different rendering physician billing the claim versus whose name was on the documentation.

NGS also revealed its pre-payment audit results for prolonged service codes 99354-99357, chiropractic codes 98940-98941, vascular diagnostic studies and osteopathic manipulative therapy, among others. Visit www.ngsmedicare.com for more information.