Pediatricians are encouraged to read the AMA’s resource on payer evaluation and management (E/M) downcoding programs to protect their practices from inappropriate payment reductions. Since 2021, changes in E/M coding allow for simplified documentation based on medical decision making (MDM) or total time spent, yet some payers have implemented algorithms that automatically downcode claims—often without reviewing medical records—resulting in lower reimbursements for services provided. This guide helps pediatricians recognize signs of downcoding, understand payer policies, navigate appeals, and strengthen documentation practices to prevent revenue loss and ensure they are paid fairly for the level of care delivered.
Click Here To Access The AMA's Resource Related To Downcoding
