2021 E/M Guidelines and Consultation Codes

Question:

I am new to an Orthopaedic practice where the coders do all the coding. The current coding staff is applying the 2021 E&M Guidelines to all encounters in the office; new, established and consultations (where the payors still recognize consultations). Is this correct? We did not do that in my former practice. I want KZA’s opinion before I bring this to the manager.

Answer:

Thanks for contacting KZA and we appreciate your support of our consultant’s expertise in Orthopaedic coding. You are correct to question this and hope this answer is timely for you to take to your manager. Today, in 2022, the 2021 E/M guidelines are for office/outpatient visit codes only (99202-99215). Consultation services or any other E&M service that does not meet the new/established patient definition will be coded with the 1995/1997 guidelines.

Congratulations on your new job—they will appreciate having you on board.