Coding-Evaluation & Management Health, Medicine, Nursing Essay

Evaluation and Management Coding
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Evaluation and Management Coding
Evaluation and management coding, which is commonly referred to as E&M coding is a process that supports medical billing. All healthcare practitioners in the United States are required to use E&M coding to receive reimbursement from programs such as Medicare and Medicaid as well as private insurance for various patient encounters. The E&M guidelines and standards were established in 1995 by the Congress and revised in 1997. E&M has been adopted by various private health insurance providers as the standards for determining the severity and type of patient conditions. This enables the health providers to bill and document for the reimbursement of the services provided. Additional codes were added to the E&M Coding set in 2010. A proper understanding of how E&M coding works helps healthcare providers to maximize payment as well as reduce the stress related to audits. Poor understanding of E&M coding can lead to defensive billing, which could end up costing the institutions huge sums of money as well as over-documenting as healthcare providers strive to justify high charges (Bendix, 2014).
The challenge of coding among medical clinicians is a reality in many institutions around the country. A 2016 study sought to explore the extent of challenges in the coding of muscle diseases and present solutions to help clinicians overcome the challenges (Jones & Ney, 2016). The authors acknowledge the critical importance of accurate coding in both research and clinical practice. They also voice the need for clinicians to be up to date with the changes in diagnostic and billing codes. To further help understand the coding practices, the article presents the case of a 68-year old man, who was sent for neurologic consultation due to dysphagia and weakness. Examination revealed that moderate-to-severe weakness of the deep right finger and thumb flexors as well as the left hip flexors. Mus...