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Team # 1005 -- Evaluation and Management Coding
Student Affairs

May 2011

Objective

Understanding and applying coding and compliance conventions of Evaluation and Management (E&M) coding can potentially improve the level of reimbursement for UHS as well as the quality of the medical record documentation.

Providing quality care while billing accurately requires:
- Doing what is medically necessary
- Documenting what you do
- Billing what you document

A cross-departmental team reviewed the use of E&M coding at UHS and assessed that we are under-utilizing E&M coding. The group developed and implemented a plan to train clinicians in how to optimize use of the codes. Health Information Management staff were trained to conduct chart reviews to assess the accuracy of our coding based on the supporting documentation.
The performance goal is that over the next year, we will reach a score of 90% accuracy of E&M coding.

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Team Membership

• Lorianne Bressler, Member
• Doris Guanowsky, Member
• Lynn Huddell, Member
• Karen Kline, Member
• Heather Miles, Member
• Chuck Moore, Member
• Evan Pattishall, Member
• Ann Shallcross, Member
• Nicole Shunk, Member
• Barbara Virgil, Member
• Lisa Witt, Member
• Nancy Lambert, Recorder

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Results Achieved to Date

• ExpectedResults:
  
  Approximately 5 patient encounters per month for each clinician will be selected for E&M coding audit by Health Information Management staff.
  
  Total records audited Aug & Sept 2011 = 182
  Total records with variance to audit = 113
  No variance = 69
  Record code under audit = 105
  Record code over audit = 8
  
  Clinicians will review individual and collective data and discuss trends and rationale for identified variances. Remeasurement, analysis and reporting will continue through Fall 2011 and Spring 2012.

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