Medicare Palmetto Jurisdiction 1 Part B: E/M Weekly Tip: Denials or Down codes

If you receive a denial or down code based on medical necessity, it is important to review the documentation submitted along with the E/M guidelines to determine the reason/cause for the denial. You may use the online E/M Checklist and Scoresheet Form to assist with auditing/selecting the E/M level. If you do not agree with the denial/down code you may appeal the service(s) within 120 days from the date of the initial determination.