Ask ten coders what counts as MEAT criteria and you’ll get ten slightly different answers. That’s a problem. Because when your coding team has inconsistent understanding of what qualifies as adequate documentation, you’re either leaving money on the table or building audit liabilities. Often both at the same time.

Here are the myths about MEAT criteria coding that I see most often, and what actually matters.

Myth #1: Medication Continuation Is Always Sufficient

A lot of coders think that if a provider mentions continuing a medication for a chronic condition, that’s adequate MEAT. “Continue Lasix for CHF” or “Refill metformin for diabetes.” They code the HCC based on that reference.

This is dangerous. Medication continuation alone doesn’t prove the condition was evaluated during this encounter. It just proves the provider knows the patient is on the medication and didn’t change it.

Real MEAT requires evidence that something was assessed. For diabetes, that might be an A1C value, a discussion of symptoms, or a review of home glucose logs. For CHF, it might be assessment of volume status, functional capacity, or current symptoms.

The medication can be part of the MEAT documentation, but it’s the “T” (treat). You still need the “E” (evaluate) or “A” (assess) to make the documentation defensible. Just renewing a prescription isn’t enough.

Myth #2: Problem Lists Count as Documentation

This myth kills more HCCs during audits than almost anything else. A condition appears on the patient’s problem list. The coder sees it there and codes it. No mention in the actual encounter note, just the problem list reference.

Problem lists don’t count as MEAT. They’re historical data, not evidence of current evaluation. CMS wants to see that the provider addressed the condition during this specific encounter, not that it exists in the patient’s overall medical record.

If the only place a condition appears is the problem list, don’t code it. You need documentation in the actual encounter note showing that the provider evaluated, assessed, or treated the condition during that visit.

Myth #3: Any Lab Value Is Adequate Evaluation

Some coders think that if there’s a lab value in the chart, that’s automatic MEAT for related conditions. Patient has a creatinine level, so CKD is documented. Patient has an A1C, so diabetes is documented.

Not quite. The lab value needs to be current (from this encounter or very recently), and ideally the provider needs to reference it in their note. A creatinine value from two years ago sitting in the lab history doesn’t support CKD coding for today’s encounter.

Also, the provider should demonstrate that they actually looked at and considered the lab value. “GFR today is 42, stable from last quarter” is much stronger than just having a GFR in the lab results with no provider comment.

Myth #4: Stable Conditions Don’t Need MEAT

I’ve heard coders say “the condition is stable, so we don’t need as much documentation.” That’s backward. Stable conditions absolutely need MEAT documentation, just like worsening conditions.

The difference is what the documentation shows. For a worsening condition, you might see treatment changes and more detailed assessment. For a stable condition, you should see evidence that the provider verified stability through evaluation.

“Diabetes remains well-controlled, A1C at target, no complications” is MEAT for stable diabetes. Just writing “diabetes stable” without any supporting evidence is not.

Myth #5: Specialists Document Better Than Primary Care

There’s a belief that specialist documentation automatically meets MEAT criteria because specialists are experts in their conditions. Cardiologists document CHF well. Endocrinologists document diabetes well.

Not always. Specialists often use shorthand with each other that doesn’t satisfy MEAT requirements. A cardiology note might say “EF 40%, euvolemic, continue current regimen” which is great clinical documentation but light on the specific MEAT elements an auditor wants to see.

Primary care doctors often provide more thorough MEAT documentation because they’re explaining their full assessment process. Don’t assume specialist notes are automatically audit-proof.

What Actually Counts

Good MEAT criteria coding requires documentation that shows one or more of these elements for each coded condition:

Monitoring through objective measures (vital signs, lab values, imaging results, exam findings). Evaluation of current status (symptoms, functional impact, disease progression). Assessment of the condition’s management (is treatment working, are there complications, what’s the clinical picture). Treatment decisions or modifications (medication adjustments, referrals, patient education, care planning).

The documentation doesn’t need all four elements. But it needs at least one element that’s specific and current to this encounter. Generic statements like “condition managed” or “continue care” don’t cut it.

The Test That Works

Here’s a simple test for MEAT criteria coding: read the documentation and ask yourself “would this stand up if a CMS auditor questioned it three years from now?”

If you have to stretch to justify the coding decision, if you’re relying on inference rather than explicit documentation, if you’re assuming the provider did things they didn’t write down, the answer is no. Code defensively, not optimistically.

When in doubt, query the provider. A simple “your note mentions the patient’s CKD, can you clarify what evaluation or treatment decisions related to kidney disease were made during this visit?” gets you what you need. Most providers can answer that in 30 seconds if you ask while the encounter is still fresh in their memory.

MEAT criteria coding isn’t complicated. But these persistent myths create inconsistency that shows up as audit failures. Get your team aligned on what actually counts as adequate documentation, not what they think should count. Your capture rates and your audit results will both improve.