A Regional Cross-Sectional Study

The halcyon days of Marcus Welby, when a doctor could simply “hang up a shingle” and be assured of a good living, are long passed. Physicians today must advertise, use lean management business practices, and, most importantly, code and bill effectively to have a financially healthy practice. This is particularly true for primary care physicians due to narrow margins and reliance on outpatient visits for the major source of their incomes. Accurate coding is also legally required for compliance with regulations from Medicare, Medicaid, and commercial payers. The challenging financial situation found in non-graduate medical education (GME) primary care practices becomes even more critical for residency/GME-based primary care practices. The tenuous financial health of these practices is threatened by high educational costs, inefficiencies characteristic of training sites, and payer mixes that are usually at the low end of the reimbursement scale. In addition to correct coding for financial and compliance reasons, residents also have an educational need to learn how to code correctly. Evaluation and Management (E&M) codes are the means by which physicians seek reimbursement from payers for the nonprocedural services they provide for patients. More complicated visits result in higher E&M codes and greater reimbursement.1 It is critical for busy resident physicians to understand E&M coding and to apply codes accurately to their outpatient encounters. Reasons for this include the funding needs of residencies, compliance with Medicare and Medicaid regulations, and educational objectives. Competency