JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS 231 Nurse Practitioner Coding Practices in Primary Care: A Retrospective Chart Review Kymberly R. Allen, MS, RN Caroline B. Reinke, MS, RN Joanne M. Pohl, Ph D, RN, CS, FAAN Kristy K. Martyn, Ph D, RN, CS, CPNP Elaine P. McIntosh, RN, CS, FNP RESEARCH INTRODUCTION While the quality of care provided by nurse practitioners (NPs) has been well established in the literature (Mundinger et al., 2000; Neale, 1999; Safriet, 1992), limited data exist regarding how they “code” for the healthcare that they provide. Coding refers to the utilization of the Healthcare Financing Administration’s (HCFA) (currently referred to as The Center for Medicare and Medicaid Services) guidelines to document the level of service for a client encounter for the purpose of billing for ser- vices. The codes established for this purpose were meant to diferentiate the complexity of care and reflect relative work values in the provision of ser- vices. Currently, the majority of relative work values are based on data pro- vided from physicians. The lack of information on NP coding practices is a consequence of reimbursement guidelines that existed prior to the Balanced Budget Act of 1997. Before the Balanced Budget Act of 1997, NPs provided and coded for healthcare services but were required to bill under a physician’s reim- bursement number (HCFA, 1998). Therefore, the services provided by NPs were hidden and embedded in the physicians’ services in national practitioner databases. This “bundling” of services for reimbursement made it difficult to accurately distinguish which healthcare providers were providing which services (Rapsilber & Anderson, 2000). Consequently, difficulty existed in differentiating NP coding practices from those of other healthcare providers. The passage of the Balanced Budget Act of 1997 established new billing guidelines that allowed NPs to bill directly to and receive reimbursement from Medicaid, Medicare Part B, and some participating commercial insur- ances for primary care services within the limits of each state’s laws (HCFA, 1998). The implementation of the Balanced Budget Act of 1997 has created a setting in which the healthcare services provided by NPs can be more accu- rately reflected (Rapsilber & Anderson, 2000). This information can now be used in healthcare research and policy to impact the future of NPs as providers of primary healthcare. The Balanced Budget Act of 1997 offers NPs the opportunity to establish themselves as independent providers of primary healthcare. Thus, it is imper- ative that NPs have advanced knowledge of HCFA’s guidelines related to cod- ing and documentation for billing purposes. The relevance of coding correct- ly for healthcare services includes the generation of an accurate practice pro- file in national databases, the receipt of proper reimbursement, and a decreased risk of lawsuits (Buppert, 2001b). As a result of the billing regulations prior to the Balanced Budget Act of 1997, limited data exist surrounding coding behaviors of NPs as individual providers. This article describes the coding and documentation practices of NPs when using the evaluation and management (E & M) codes in an acad- emic primary care center. Purpose To describe the coding and documentation practices of nurse practitioners (NPs) when using evaluation and management (E & M) codes in an academic primary care center. Data Sources A randomized retrospective review of ten charts from a nurse-managed primary care clinic affiliated with a midwestern research- intensive university. Conclusuion The findings demonstrate that the documenta- tion in the chart for six of the ten client encounters did not support the E & M codes assigned by the clinicís NPs. Four of these six client encounters were overcoded; the remain- ing two encounters were undercoded. Implications for Practice Findings of this study support the need for additional education of NPs in the areas of coding and documentation. Key Words Coding; billing; nurse practitioner; reimburse- ment; legal issues; advanced practice nursing. Authors Kymberly R. Allen, MS, RN, was formerly a graduate student at the University of Michigan. Caroline B. Reinke, MS, RN, was formerly a graduate student at the University of Michigan. Joanne M. Pohl, Ph D, RN, CS, FAAN, is an Associate Professor and Associate Dean, Office of Community Partnerships, Kristy K. Martyn, Ph D, RN, CS, CPNP, is an Assistant Professor, and Elaine P. McIntosh, RN, CS, FNP, is the Director of Nurse Managed Centers at the University of Michigan School of Nursing, Ann Arbor, MI. Contact Ms. Allen by email at kymallen@yahoo.com