Recent developments in evaluation and management services

Evaluation and management services are important aspects of interventional pain management; however, significant confusion continues as to proper coding and documentation in this field. In addition, recent developments in the area of evaluation and management services over the last few months are of significance to interventional pain physicians. Two major developments in the year 2000 include a warning from the Health Care Financing Administration (HCFA) with regards to misused codes, and issue of new draft evaluation and management guidelines to improve physician acceptance by simplification. The HCFA has sent letters to all physicians in the United States on June 1, 2000, with information that it will be focusing this year on two current procedural terminology (CPT) codes used to report evaluation and management services - 99214 and 99233. The HCFA contends that these codes accounted for a significant portion of coding errors in the last two audits and that documentation for many of these services was found to be sufficient only to support services more appropriately described by CPT codes 99212 and 99231 resulting in downcoding by two levels by HCFA and implying that physicians are upcoding by two levels. The second issue relates to the release of yet another version of the new draft evaluation and management guidelines by HCFA in June 2000. These were preceded by an article by the administrator of HCFA, Nancy-Ann Min DeParle, which was published in JAMA. The new guidelines are purported to eliminate "bullets" and "shading"; reduce the need for counting the "elements"; introduce the first specialty-specific vignettes; and include a nationwide study of the new proposed guidelines.