07/21/2025

ASCO's Coding Tip of the Month

When choosing a level of service for office visits and other related evaluation and management codes, two of three categories of medical decision making must be met or exceeded in order to assign a specific level of service.

A high-level problem of risk of morbidity or mortality does not necessarily equate to a high level of medical decision-making without a high level of either problem addressed OR data. ASCO’s resource on Medical Decision-Making Simplified has more information to better understand the levels and how to select an appropriate level for your evaluation and management service. This and other related resources can be found on ASCO’s Coding and Reimbursement page.

It’s critical to clearly communicate the thought process and rationale used in the documentation of a service (“showing your work”). Documentation not easily understood to all who read the note can lead to prior authorization and claims denials, down coded visits, along with other ramifications.