Providers Increasingly Code Outpatient Care at Higher Complexity Levels

  • 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
  • Jinghong Chen

    Jinghong has been producing infographics and data stories on employer-sponsored insurance, public health insurance programs and prescription drug coverage for AIS Health’s Health Plan Weekly and Radar on Drug Benefits since 2018. She also manages AIS Health’s annual executive compensation database for top insurers and Blue Cross and Blue Shield affiliates. Before joining AIS Health, she interned at WBEZ, Al Jazeera English and The New York Times Chinese. She graduated from Missouri School of Journalism with a focus on data journalism and international reporting.

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