Coding for High-Complexity Office Visits on the Rise

Outpatient E/M visits, also known as office visits, are billed by providers with a complexity of 1-5, based on the level of medical decision making required or time associated with the visit. The level of complexity affects the amount paid to the provider. The increases in high-complexity coding identified in the study were consistent across age categories, geographic regions, insurance types, and most provider specialties.

While more research is needed to understand the increase in level 4 and 5 codes, these trends show the importance of health plans’ efforts – including Elevance Health’s current initiatives – to ensure coding appropriateness and prevent unnecessary cost increases for patients, employers, and other payers.