Office visits represent a huge proportion of revenue for most practice types. It’s easy for small errors in coding to become habitual, and the resulting inaccuracy can be costly for your practice. Under-coding can mean lost revenue — multiplied by hundreds or even thousands of visits per year. Accidental over-coding can lead to revenue clawbacks that create accounting hassles and make it more difficult to accurately project revenue.

Payers are very concerned about E/M accurate coding, too. That’s why any variation (not just over-coding) can be a trigger for a payer audit.

Checking your E/M coding patterns against Medicare’s utilization data for your specialty is a quick way to spot possible problems. If your or your practice’s code utilization differs significantly from national data and the reasons aren’t immediately clear, it could be time for a closer review or internal chart audit.

Getting your hands on the CMS data, then entering it into a spreadsheet, can be a bit time-consuming — but we’ve taken care of some of the grunt work for you.

Follow the links below to download a spreadsheet that already has the CMS 2017* data keyed. It includes  formulas to calculate your clinicians’ or your practice’s utilization of each code, and compare it with the national averages. Just enter your data and get your results immediately.

Allergy and immunology
Family practice
General practice
General surgery
Internal medicine
Orthopedic surgery
Pulmonary disease

Need a different specialty?  Contact us and we’ll pull it together for you, provided the CMS has published data for it.

Besides comparing against the CMS numbers, we recommend you compare your clinicians’ numbers against each other. Sometimes, differences in utilization make perfect sense — such as when the doctors see distinctly different patient populations. But not always. If the variances don’t look logical to you, it’s time to take a closer look. You may find it’s time to bring in an E/M coding expert for a customized refresher course and/or chart audit. (If you need this help, contact us.)


*here’s a link to the source document from the CMS.  You can find it with other Medicare downloads on this page, if you are interested in diving into more data on your own. As of the date of this post, this is the most recent CMS-Medicare Part B utilization data available.


About the Author: Laurie Morgan

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