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New approach aims to educate and reduce E&M billing errors

The proper coding of evaluation and management (E&M) services is a well-known challenge for many providers. Because providers are faced with the difficult task of determining which level of CPT code appropriately reflects the complexity of the visit, E&M coding constitutes a high percentage of errors compared to coding for other services.

In an attempt to help providers and their offices facilitate correct coding, Magellan has contracted with Change Healthcare to implement their Coding Advisor program. Coding Advisor will review the use of E&M codes, psychotherapy assessments, and the billing of modifier 25 for providers submitting claims to Magellan. The program’s aim is to provide useful data insights to providers, maximize coding efficiency and accuracy through education, and reduce the burdens associated with traditional audits.

In the coming months, Change Healthcare will initiate outreach to qualifying providers who are submitting claims to Magellan. This may consist of outbound notification letters, education-based telephone calls, and clearinghouse-level claim status messaging. 

Throughout the course of this program, Change Healthcare will continue to monitor billing practices, and will send updated reports periodically. They may contact your practice with the intention of identifying any coding discrepancies and performing one-on-one coding consultation. All correspondence will be sent to you from Change Healthcare.