Are you prepared to defend your coding?

Have you gotten the health plan notice identifying you as a coding outlier and accusing you of reporting a greater than average number of high-intensity evaluation and management (E/M) codes. If you aren't sure how to defend your coding and documentation patterns, help is available. The best defense is a strong offense in the form of a coding and documentation compliance plan. When a payer uses profiling data to look for overcoding and missing documentation, your best defense will be having a compliance plan that includes coding education and routine chart reviews. At the least, your compliance plan should include an annual review of any chart templates used and any risk areas identified since the last review. If you receive "the letter" indicating that your CPT coding or cost per patient is not in line with your peers, don't panic and don't ignore it. Your first step should be responding to the payer. You'll need to request more information on how and against whom your provision of services varies.