The OIG Reviewing Evaluation and Management (E/M) Services

The Office of Inspector General has released its Work Plan for fiscal year 2011. In it, the OIG indicates that evaluation and management (E&M) claims will be reviewed, to identify trends in coding, including a review to determine whether coding patterns vary by provider characteristics.

Additionally, the OIG will conduct a separate review of potentially inappropriate payments for E&M services and the consistency of E&M medical review determinations. Medicare contractors have indicated an increased frequency of medical records with identical documentation across services.

ISIS members are encouraged to familiarize themselves with the E/M coding guidelines to assure compliance with documentation requirements.