Study confirms: Even experts confused by Medicare coding

Specialized coding agencies can't agree on proper E&M codes.

By Markian Hawryluk, AMNews staff. Sept. 16, 2002.

Washington -- A new study bolsters what many physicians have claimed for years -- Medicare's evaluation and management coding process is horribly confusing.

Researchers from the Dept. of Emergency Medicine at the William Beaumont Hospital System in Royal Oak, Mich., set out to determine how well even experts could do in appropriately coding emergency department visits.

The study, published in the September issue of Annals of Emergency Medicine, looked at the five E&M codes that represent 70% of the codes emergency physicians use to bill for their services.

The researchers, led by Raymond Jackson, MD, sent copies of 389 medical records to four private coding firms and asked them to correctly assign codes to the emergency department visits documented in the charts. They found little consensus.

The agencies agreed on the proper coding in only 15% of the charts. In 6%, the four coding firms came up with four different codes. And in 29% of the records, the coders disagreed by more than two code levels.

The study also compared the coding decisions made by four coders within the same coding agency. The results were only slightly better.

"We wonder whether an individual coder would code the same record similarly over time," the researchers said.

The researchers suggested improving the coding system by creating templates that would direct doctors toward more consistent documentation. They also suggested a more rigorous formatting of dictations to produce more consistent documentation and clearer and more explicit guidelines to explain the differences between E&M coding levels. [...]