2019 - E & M Coding Changes

This will go into effect in the year 2021...

The AMA CPT Editorial Panel has approved revised guidelines for new and established office or outpatient visit codes 99202-99215 that would eliminate history and examination as key components to select the E/M service level. Additional E/M documentation changes include the deletion of level one new outpatient visit code 99201, and revisions to codes for prolonged services with or without patient contact.

Below are the major changes w.e.f Jan 1, 2021

I. Accepted deletion of code 99201

II. Revision of codes 99202-99215 as follows:

(A) removing history and examination as key components for selecting the level of E/M service, but adding the requirement that a medically appropriate history and/or examination must be performed in order to report codes 99202-99215;

(B) making the basis for code selection either the level of medical decision making (MDM) performed or the total time spent performing the service on the day of the encounter;

(C) changing the definition of the time element associated with codes 99202-99215 from typical face-to-face time to total time spent on the day of the encounter, and changing the amount of time associated with each code; revision of the MDM elements associated with codes 99202-99215 as follows:

(i) revising “Number of Diagnoses or Management Options” to “Number and Complexity of Problems Addressed”;
(ii) revising “Amount and/or Complexity of Data to be Reviewed” to “Amount and/or Complexity of Data to be Reviewed and Analyzed”; and
(iii) revising “Risk of Complications and/or Morbidity or Mortality” to “Risk of Complications and/or Morbidity or Mortality of Patient Management”; revision of the E/M guidelines by:

(A) restructuring the guidelines into three sections: “Guidelines Common to All E/M Services”, “Guidelines for Hospital Observation, Hospital Inpatient, Consultations, Emergency Department, Nursing Facility, Domiciliary, Rest Home or Custodial Care and Home E/M Services”, and “Guidelines for Office or Other Outpatient E/M Services” to distinguish the new reporting guidelines for the Office or Other Outpatient Services codes 99202-99215;

(B) adding new guidelines that are applicable only to Office or Other Outpatient codes (99202-99215); adding a Summary of Guideline Differences table of the differences between the different sets of guidelines;

(C) revised existing E/M guidelines to ensure there is no conflicting information between the different sets of guidelines;

(D) adding definitions of terms associated with the elements of MDM applicable to codes 99202-99215;

(E) adding a MDM table that is applicable to codes 99202-99215;

(F) defining total time associated with codes 99202 - 99215;

(G) adding guidelines for reporting time when more than one individual performs distinct parts of an E/M service; revision of the Medical Decision Making table in the Amount and/or Complexity of Data to be Reviewed and Analyzed column:

(1) inserted a dash (-) after the asterisk in the asterisk definition, “* - Each unique test, order, or document may be summed if multiple,” to clarify this is the meaning of the asterisk and not an asterisked item itself;

(2) for limited amount of data to be reviewed and analyzed (codes 99203/99213), the parenthetical regarding the number of categories for which requirements must be met was revised to state, “…categories of tests and documents, or independent historian(s)” rather than “categories within tests, documents, or independent historian(s)”; and

(3) removing the word “or” after each of the bulleted items for limited, moderate (codes 99202/99214), and high (99205/99215) amount and/or complexity of data to be reviewed and analyzed

Prolonged Services With or Without Patient Contact

Accepted revision of codes 99354, 99355 to exclude reporting of Office and other Outpatient Services codes, and revision of 99356 to include observation; revision of the prolonged services guidelines; addition of new code 99XXX to report prolonged office or other outpatient E/M services.

Comments

Vascular Catheterization - Coding

Vascular system anatomy and terminology to make reporting these procedures less challenging. A thorough understanding of the anatomy and medical terminology of the vascular system is required to accurately code arterial vessel procedures. Here’s a quick run-through of clinical information and coding guidance to show you how order affects coding. Order Matters Please refer to Appendix L of the CPT® code book for the vascular families. The aorta is the major artery. Each main vessel branching off the aorta is a first order vessel (e.g., left common carotid). First order vessels have several vessels branching off them, designated as second order vessels (e.g., right subclavian and axillary). Second order vessels have several vessels branching off them, designated as third order vessels (e.g., right internal carotid). Third order vessels have several smaller vessels branching off them, designated as beyond the third order (e.g., left deep palmar arch). Catheterization Can Ei...

CPT Quiz - 40000 Series

Quiz created by Vijayarani Sivakumar with GoConqr

Injections & Infusions Coding

Here are the three basic coding rules that you must adhere to when billing for Injection/Infusion services: Rule #1: Pay Attention to the Administration Route When you’re looking at the treatment note, you can first look for hints to proper coding by identifying the Route of Administration. the Injection/Infusion CPT® codes fall into one of three major categories: 1. Intravenous Infusions (IV) 2. Intravenous Pushes (IP) 3. Injections (Sub-Q, IM) Don’t forget: The Centers for Medicare & Medicaid Services (CMS) regulations look at the way a drug is administered only as “the physical process by which the drug enters the patient’s body” – not whether a medical professional administers the drug or supervises the administration. But the administration route hierarchy isn’t the only one you need to understand for Injection/Infusion coding — there is another hierarchy for the type of agent that works in tandem with the administration one. Rule #2: Unde...

Place Holder X

The letter " x ” serves as a placeholder when a code contains fewer than six characters and a seventh character applies. The " x ” also allows for future expansion of the codes. When reporting ICD - 10 - CM codes, coders must add a placeholder so the seventh character is in the correct position. Not every ICD-10-CM code with a seventh character has a sixth character—or even a fifth or fourth character for that matter. This frequently occurs with poisonings and injuries. The letter "x” serves as a placeholder when a code contains fewer than six characters and a seventh character applies. The "x” also allows for future expansion of the codes. When reporting ICD-10-CM codes, coders must add a placeholder so the seventh character is in the correct position. Without this placeholder to ensure characters appear in the correct positions, codes are invalid. For example, a patient presents with an accidental poisoning by an antiallergic drug. For the initial ...

Systemic vs. Pulmonary Circulation

What Does the Heart Do? The heart is a pump, usually beating about 60 to 100 times per minute. With each heartbeat, the heart sends blood throughout our bodies, carrying oxygen to every cell. After delivering the oxygen, the blood returns to the heart. The heart then sends the blood to the lungs to pick up more oxygen. This cycle repeats over and over again. What Does the Circulatory System Do? The circulatory system is made up of blood vessels that carry blood away from and towards the heart. Arteries carry blood away from the heart and veins carry blood back to the heart. The circulatory system carries oxygen, nutrients, and hormones to cells, and removes waste products, like carbon dioxide. These roadways travel in one direction only, to keep things going where they should. What Are the Parts of the Heart? The heart has four chambers — two on top and two on bottom: · ...

Burns and Corrosions

Chemicals, such as lye or acid, can cause corrosion upon contact with a person's skin. As a professional coding specialist, you may need to code the diagnosis of a burn or corrosion. A chemical burn occurs when living tissue is exposed to a corrosive substance such as a strong acid or base. Chemical burns follow standard burn classification and may cause extensive tissue damage. Burns from a heat source are classified by depth (first, second, third, unspecified), extent, and agent. For multiple burns, sequence the highest degree burn first. Multiple burns of the same three-character category are coded to the highest degree. Non-healing burns are coded as acute burns. The extent of injury is best described using the percentage of the total body surface area (%TBSA) that is affected by a burn. The measurement of burn surface area is important during the initial management of people with burns for estimating fluid requirements and determining need for transfer to a burns service T...

Allograft vs Autograft vs Xenograft

Allo – Same species Auto – Same person Xeno – Animal (different species) An autologous transplant uses a person's own stem cells. ... In a reduced-intensity allogeneic transplant, doctors suppress the recipient's immune system enough so the donor stem cells can take root, or “engraft,” there. An autograft is a bone or tissue that is taken from a part of a person’s own body and transplanted into another. Often, surgeons will use a person’s own hamstring tendon to repair a damaged anterior cruciate ligament. Similarly, an autograft bone may be transplanted from a person’s hip to aide in a spinal fusion. Patients who undergo autograft procedures may experience increased postoperative pain from the second surgical (autograft) site. They may also require longer periods of rehabilitation. The use of allograft is advantageous because there is no second procedure required to remove and transfer a portion of the patient’s native bone or tissue. Surgical time may be...

Combination Codes

It’s one of the most important questions coders must ask while using ICD-10: Is there a single combination code that fully identifies the patient’s relevant conditions, or is it necessary to report two separate codes? The volume of combination codes in ICD-10 has increased, making it imperative for coders to be alert and aware of instances in which combination codes are applicable. Defining Combination Codes The ICD-10-CM Official Guidelines for Coding and Reporting describe combination codes as those used to classify the following: • Two diagnoses • A diagnosis with an associated secondary process (manifestation) • A diagnosis with an associated complication Coders cannot — and should not — assign multiple diagnosis codes when a single combination code clearly identifies all aspects of the patient’s diagnosis. For example, say a pati...

ICD-11

After the tumultuous transition to the 10th International Classification of Diseases, simply saying the phrase “ICD-11″ is liable to strike fear in the hearts of medical providers across the country. But the inevitable truth is that ICD-11 is looming large on the healthcare horizon, and physicians who are unprepared for this transition will see an uptick in rejected claims and a drop in reimbursements—so preparation is key. In this article, we’ll go over a detailed timeline to help you create deadlines for yourself and pace out your own transition from ICD-10 to ICD-11, all while avoiding complicated diagnostic issues that could impact your revenue cycle. What is ICD-11? ICD-11 is the newest iteration of the International Classification of Diseases scheduled to take effect in January 2022. As you probably already know, ICD-10 was introduced way back in 1992, and it took the U.S. 23 years to completely transition to it. So after only having completed that arduous ...

Complete List of Modifiers

Modifier - as the name implies a modifier will modify a service / procedure or an item under certain circumstances for appropriate reimbursement. Modifiers may add information or change the description according to the physician documentation to give more specificity for the service or procedure rendered. Appending of an appropriate modifier will effectively respond to reimbursement. Modifier are two digit codes and are categorized into two levels 1. Level I Modifiers: Normally known as CPT Modifiers and consists of two numeric digits and are updated annually by AMA - American Medical Association. 2. Level II Modifiers: Normally known as HCPCS Modifiers and consists of two digits (Alpha / Alphanumeric characters) in the sequence AA through VP. These modifiers are annually updated by CMS - Centres for Medicare and Medicaid Services. Both the above levels of Modifiers are recognized nationally. List of Level I Modifiers: Modifier -21 Prolonged Evaluation and Man...

Medical Coding Simplified

Search This Blog