2022-19:Leveling of Care: Evaluation and Management Overcoding

Date: 08/08/22

Louisiana Healthcare Connections implemented a process to manually monitor claims billed for Evaluation and Management services based on the 2021 guidelines. This manual review was implemented to determine the appropriateness of the billed Level of Care: Evaluation and Management coding based on diagnosis, claims documentation, and time spent with the patient.

As a result of this policy implementation, Louisiana Healthcare Connections may have reduced claims reimbursement to reflect the maximum level of E&M service based upon the documentation submitted with the claim.

We have determined that the reduction in reimbursement to a lower level of service (i.e. down coding) was inappropriate. If your reimbursement was reduced, claims will be automatically recycled to pay as billed and you should take no action at this time.