The HHS Office of the Inspector General (OIG) released a report on E/M coding this week that shows levels 4 and 5 selection for established 
patient office visits is on the rise this past decade while levels 1 through 3 selection is on the decline.
The portion of established patient E/M codes billed as levels 1 through 3 dropped by a combined 17% between 2001 and 2010 and selection of levels 4 and 5 account for a 17% higher portion during that same timeframe, according to the report – available here.
But the real target of the report are the physicians landing at the very top – who in 2010 billed either level 4 or 5 for at least 95% of total services billed within a single visit type.
The report includes a back and forth between OIG and CMS that chronicles the following:
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OIG has sent to CMS the names of those 1,700 suspicious physicians and is recommending that CMS review their claims and recover overpayments of any inappropriate claims.
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CMS sent a letter to OIG which says the Medicare agency will agree to OIG’s first two recommendations – provide E/M billing education to all physicians, encourage Medicare administrative contractors (MACs) to review E/M billing in order to produce comparative billing reports – but only partially agreed to the above recommendation to target those 1,700 physicians for recoupment. Instead, CMS vowed to forward the list of 1,700 physicians to the MACs and will “direct each contractor to focus on the top 10 high billers in their jurisdiction…Based on the results of those reviews we will determine how best to address the remaining high billers.”
We’ll have more extensive coverage on this report in an upcoming issue of Part B News, but one key clarification to make is that OIG does not describe any evidence of inappropriate billing in this report. OIG does state that it will issue more reports in the future that will examine the appropriateness of the 1,700 high-billing physicians’ E/M claims.