Teaching Physician Rules Related to E&M Code Selection

Question:

We are an academic orthopaedic practice with an orthopaedic GME-approved residency program in a large metropolitan city. We were just informed we have been incorrectly reporting E&M codes 99202-99215 to Medicare since January 2022.

We select the level of service based on MDM or time, as we understood this to be correct. We were told we should not be reporting Medicare E&M services based on time and must use MDM only when coding E&M services.

Have we been coding incorrectly when using time versus MDM when time better supports the level of service? We do not include resident time or resident education when calculating time.

Answer:

Thanks for your inquiry. There was a change in the Medicare Teaching Physician Rules related to E&M code selection effective January 2022; however, the changes would not apply in your specialty. The rules apply to a setting where the primary care exception applies. To read more on the primary care exception and where it may apply in your academic setting, visithttps://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/teaching-physicians-fact-sheet-icn006437.pdf

Perhaps this citation from a Medicare MAC was interpreted incorrectly, hence, the information you received.

New Medicare requirements on documenting E/M services by teaching physicians – effective January 1
Exception for evaluation and management (E/M) services in certain primary care centers
Effective January 1, teaching physicians may use only medical decision making (MDM) for purposes of E/M visit level selection when billing the Medicare program under the physician fee schedule for office/outpatient E/M visits via a primary care exception.

Time-Based Codes
Additional updates apply to office/outpatient E/M visit codes for which total time is used for the visit level selection. For purposes of selecting the visit level, only count time spent by the teaching physician performing qualifying activities listed by CPT (with or without direct patient contact on the date of the encounter), including the time the teaching physician is present when a resident is performing such activities.