TheCMS Medicare Administrative Contractor (MAC), Palmetto GBA recently published the results from prepayment reviews of Evaluation and Management codes 99204 and 99205.

Evaluation and Management services are the most commonly provided service and the most likely to be subject to miss-coding.  CMS and individual MAC’s have published numerous guides, fact sheets and even an interactive coding tool to assist providers in selecting the proper level of the E and M service.

 Follow these links for helpful information on E and M coding:

Documentation Guidelines for Evaluation and Management (E/M) Services

Evaluation and Management Services Guide

This brought to my attention, maybe there are other MAC’s currently scrutinizing the same or similar services in their jurisdictions.  And, maybe there are providers out there that are unaware that they are undergoing a “Prepayment Review” when they are passing on their charge code to office staff.  So, with that in mind, I researched the information found on each MAC website and compiled a location and procedure list.  Since the procedures selected are known to be both performed at a high volume and have a high error rate, by reviewing the criteria for these codes, a provider can ensure he/she is compliant when making a code selection.