How does your E&M coding compare to other allergists?

May 20, 2019

Have you wondered how your coding distribution for Evaluation and Management (E&M) services compares to other allergists? Medicare publicly reports specialty-specific E&M utilization data, which they use to identify providers who are overcoding. But this data is also useful if you want to know how your coding compares to your peers.

2017 Medicare E&M code usage for allergy/immunology, the latest information available, is summarized below, and the distribution is very similar to 2016. For new patient visits, the most common code used by allergists was a level 4 at 57% of the time. Level 3 was the next most common, at nearly 33%. Not surprisingly, levels 1 and 2 were infrequently used, and level 5 was used less than 8% of the time.

E&M Code
(new patient)
Allergy / Immunology 2017 Medicare UsageAllergy / Immunology 2017 Medicare Utilization % by Code
992013030.2%
992023,6002.1%
9920355,79532.9%
9920496,88157.1%
9920513,1407.7%
Total169,719100.0%

Source: Medicare Part B Physician/Supplier National Data CY2017, E&M Codes for Allergy/Immunology

For existing patient visits, level 3 was the most common at 51%, followed by level 4 at 39%. Levels 1, 2 and 5 were used infrequently.

E&M Code
(existing patient)
Allergy / Immunology 2017 Medicare UsageAllergy / Immunology 2017 Medicare Utilization % by Code
9921124,7603.1%
9921236,9304.6%
99213408,78950.8%
99214312,25438.8%
9921521,7712.7%
Total804,504100.0%

Source: Medicare Part B Physician/Supplier National Data CY2017, E&M Codes for Allergy/Immunology

Kay Tyler, vice-chair of the Practice Management Committee and CEO of Family Allergy & Asthma in Louisville, KY, regularly analyzes Medicare E&M data. “We have been using the CMS data for a number of years and provide this feedback to each physician every year. It is helpful in identifying outliers and opportunities for training. Most physicians won’t know the exact differences in how to code a Level 3, 4, or 5. The coding requirements are very specific, and we use this data to reinforce accuracy.”

You may want to pull your own historical coding data from your practice management system to see how it compares to the average Medicare coding distribution for allergists/immunologists. If you find one of your providers – or your practice in total – is an outlier relative to this data, consider having a certified coder review your charts to make sure you are coding accurately. Keep in mind, however, that every practice has a different demographic of patients, and your own experience may not be directly comparable to the Medicare average.

Also, it’s critical to make sure your documentation supports the coding level for every visit. An Office of Inspector General (OIG) report from 2010 found 55% of claims for E&M services were incorrectly coded and/or lacking documentation. In addition, a total of 26% of claims were incorrectly upcoded. E&M coding has long been an OIG audit target, so make sure you’re coding and documenting correctly to avoid penalties and fines.