Mastering Coding and Compliance

Coding and Compliance Reports Can Help Boost Revenue

Running regular assessments of your coding service levels can help isolate areas of documentation and coding that require further review. This is a healthy habit to get into from both compliance and revenue cycle perspectives. The CPSC E&M Analysis generates standard online reports that allow users to compare provider coding patterns with local averages and CPSC specialty-specific benchmarks.

These comparative analytic reports are used by clinical department leaders, billing managers and compliance departments to:

  • Support compliance audits
  • Monitor consistency between coding and documentation
  • Identify specialties and providers for coding education efforts
  • Measure the impact of coding education programs


Solving for Local Coding and Compliance Variations

Your coding operations often vary by clinical site — especially across wide-ranging networks. Pair the CPSC Procedure Summary report with the E&M Analysis reports to identify coding variances by clinic location and eliminate localized discrepancies that affect revenue.

Case Study: UC Davis Uncovers Variation in Coding by Clinic Location

Like physicians in many academic groups, the faculty of UC Davis Medical Group work in various clinic locations — the acute-care hospital, affiliated outpatient centers and a primary care network in 15 northern California communities.


“The E&M reports make it a simple process to review coding and add value to our work without much extra effort on our part.”

During a CPSC training visit, the UC Davis team discovered how differences in staffing and operational processes at their clinic locations affect both coding and revenue. Using the Procedure Summary Report, a department administrator identified significant variations in outpatient E&M coding by practice location despite similarities in patient mix and acuity. Information like this is vital to an organization’s bottom line.

Why Members Use the E&M Coding Opportunity Assessment Tool

Leveraging our vast database, our E&M Analysis reports help you identify coding patterns that vary from the CPSC benchmarks. Then our E&M Coding Opportunity Assessment tool adds another level of detail to the comparison: payments. Using Medicare rates, your payments are estimated at your current E&M coding distribution and then compared with payments at the CPSC mean coding distribution level.

Negative variances in this report show coding patterns that are more conservative than the norm. Positive variances show coding patterns that are more aggressive than the norm. Understanding where your organization falls on this spectrum will create a clear path forward for your coding distribution policies.

Should You Perform a Consultation Code Usage Analysis?

Getting a better handle on managing consultation code usage has proven to be profitable for certain kinds of organizations. Specialists, in particular, must ensure that the patients referred to them for consult are billed as such rather than as new patients.

Our Consultation Code Usage analysis measures “outpatient consults” (99241-99245) as a percentage of “outpatient consults plus new patient visits” and then compares it with the specialty-specific averages within the massive CPSC database. This information can help guide your coding policy so that you aren’t leaving money on the table.