Providers Increasingly Code Outpatient Care at Higher Complexity Levels
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Mar 24, 2023
Outpatient visits to a physician’s office, urgent care center or emergency department were coded at higher levels from 2004 to 2021, leading to substantial increases in health care spending, according to Peterson-Kaiser Family Foundation Health System Tracker.
Providers and facilities bill outpatient evaluation and management claims based on visit complexity at five levels. Level 1 visits have the lowest complexity cases, with less time required or straightforward medical decision-making, while level 5 visits are the highest complexity cases, with more time required or very complex medical decision-making. Payers generally pay larger reimbursements, and patients with deductibles may pay more out-of-pocket, for visits with higher complexity. Read more© 2024 MMIT
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