Trends in High-Complexity Office Visit Coding

This report presents an analysis of trends in the coding of high-complexity outpatient Evaluation and Management (E/M) visits from 2006 to 2022. It documents the increase in the proportion of E/M visits coded as high-complexity (levels 4 and 5), which rose from 25 percent in 2006 to 38 percent in 2022. The report details the methods used to analyze a sample of claims from commercially insured, Medicare, and Medicaid patients, providing insights into the characteristics of visits and the associated costs. The findings indicate that higher complexity coding correlates with increased costs for both patients and payers. The analysis includes trends across various demographics, insurance types, and provider specialties, noting that the increase in high-complexity coding was consistent across age groups and regions, despite a temporary decline during the COVID-19 pandemic. The report concludes with implications for healthcare costs and the coding practices of providers.