Comprehensive Error Rate Testing
CERT Services Contributing to the Error Rate
Analysis of current CERT error data shows that 50% of the claim detail line errors assessed by the CERT Contractor were for Evaluation and Management procedure codes. The top error categories involved were:
Services incorrectly coded - 64%
Insufficient documentation - 18%
No documentation/Response received-improper documentation - 17%
Incorrect coding errors for E/M services were primarily associated with billing the incorrect level of service. Incorrect coding errors most often occurred for procedure codes 99213-99215 (established office visits), 99232-99233 (subsequent hospital visits), 99243-99245 (outpatient consultations) and 99252-99255 (initial inpatient consultations).
In the majority of these cases, the CERT review found that the service was billed at a higher level than what was substantiated through the documentation submitted. Over 50% of these instances involved down coding of one level.
These results illustrate the importance of keeping documentation which supports all of the required components for the level of Evaluation and Management service billed. The medical necessity of the level billed must also be supported in the documentation.
To provide additional education on this topic, we are pleased to offer several upcoming seminars regarding documentation of Evaluation and Management services. To find a location near you, please visit our Education Schedule.
