Healthcare expenditures account for an estimated 18 percent of the United States’ gross domestic product. A 2014 BMC Health Services Research study (“Billing and Insurance-related Administrative Costs in United States’ Health Care”) found that in 2012 billing and insurance-related administrative costs alone totaled $471 billion—nearly one-fifth of all healthcare costs.

While I celebrate the coding profession’s growth, also I understand that coding is an administrative cost. Due to my experiences, I feel coding evaluation and management (E/M) services is a particularly onerous administrative burden. I attribute this burden to these primary factors:

Let’s consider the E/M rules and problems we face when coding an E/M service.

Selecting the category of service requires identifying the place of service, which is not always clear. As patients move between hospital departments, their assigned status of inpatient, outpatient, or emergency room may change (sometimes after the fact) based on regulations or payer guidelines. Even...

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