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Coding for High-Complexity Office Visits on the Rise

August 2023
Full report

From 2006 to 2022, the percentage of outpatient evaluation and management (E/M) visits coded as high-complexity (level 4 or 5) steadily increased from 25 percent to 38 percent of visits. Overall and patient-paid costs rose over time due to this increase in coding complexity.

Outpatient E/M visits, also known as office visits, are billed by providers with a complexity of 1-5, based on the level of medical decision making required or time associated with the visit. The level of complexity affects the amount paid to the provider. The increases in high-complexity coding identified in the study were consistent across age categories, geographic regions, insurance types, and most provider specialties.

While more research is needed to understand the increase in level 4 and 5 codes, these trends show the importance of health plans’ efforts – including Elevance Health’s current initiatives – to ensure coding appropriateness and prevent unnecessary cost increases for patients, employers, and other payers.


  • Background on Coding
  • Study Methods
  • Coding Trends Analysis
  • Cost Analysis
  • Discussion & Implications

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