July 16, 2020
The proper coding of Evaluation and Management (E&M) services can be a challenge. Providers have 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 mistakes compared to coding for other services.
To help facilitate correct coding, Premera is working with Change Healthcare to implement their solution called Coding Advisor. Coding Advisor reviews the use of E&M codes, Psychotherapy Assessments, and the billing of modifier 25 for submitted claims. The program's aim is to provide useful data insights to the provider community, maximize coding efficiency and accuracy through education, and reduce the burdens associated with traditional audits.
Beginning in August, Coding Advisor will initiate outreach to providers who are submitting claims to Premera. This campaign will consist of a series of communications which may include letters, education-based phone calls, and clearinghouse-level claim status messaging.
Throughout the course of this program, Coding Advisor monitors billing practices and sends updated reports periodically. They may contact your practice with the intention of identifying any coding discrepancies and to perform one-on-one coding education. All correspondences will be sent to you from Change Healthcare.
If you have questions, call Change Healthcare Coding Advisor's Customer Support at 844-592-7009, option 3.