Medicare can deny or downcode an evaluation and management (E/M) service if it feels that the service provided exceeds the patient's documented needs.

Question

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Medicare has guidelines and criteria for E/M services, and if a provider documents more than what is necessary for the patient's condition or history, Medicare may deny or downcode the service. This is why it is important for providers to accurately document the level of service provided.

Medicare Can Deny or Downcode an Evaluation and Management (E/M)