Where do you fall on the coding curve?

Besides government investigators, commercial payers also track your coding practices to see if they fall within the normal bell curve for your specialty.

All insurers, including Medicare, benchmark physician evaluation and management (E/M) coding to develop benchmark claim patterns that they then use to help flag practices that fall outside the norm. You can do the same thing to see how your practice compares.

Performing your own in-house comparison helps you learn where you fall on the curve — and why — which can be helpful in evaluating your patient mix and coding habits. It also can help you explain any suspicious-looking patterns to auditors.

Here are some of the common elements investigators use when creating the coding benchmarks they choose to track:

  • amount of physician documentation;
  • specialty (and sub-specialization within a specialty);
  • diagnostic focus (i.e., the type of conditions treated);
  • diagnostic severity;
  • patient mix;
  • practice style;
  • place of service.