Confusion About New 2021 E/M Guidelines

Question:

The new guidelines that are coming out in 2021 for all types of E/M services, right?

Answer:

No. The new guidelines are for office/outpatient visit codes only (99202-99215). You will still need to use the current guidelines for all other E/M services, even consultations in the office.

*This response is based on the best information available as of 05/19/22.

Abdominal Fat Pad Core Biopsy

Question:

We did an abdominal fat pad biopsy for primary cutaneous Amyloidosis. Would 49180 or 11104 be the appropriate code for this?

Answer:

49180 is for a core sample within or behind the abdominal cavity. If the core biopsy is documented down to the subcutaneous fat pad only, this is coded as a punch biopsy 11104. And if the provider documents ultrasound guidance with proper documentation (i.e., noting anatomical findings and needle placement), 76942 can be billed as well with modifier 26 if indicated.

*This response is based on the best information available as of 05/05/22.

Coding a Hand Assisted Laparoscopy

Question:

The surgeon described the procedure as a ‘hand assisted laparoscopy”. He brought part of the bowel outside of the body for evaluation. Does this convert the procedure to open?

Answer:

Mobilizing the bowel outside the body (extracorporeally) during a laparoscopic procedure does not convert the procedure to open, it is still considered a laparoscopic procedure and coded as laparoscopic.

*This response is based on the best information available as of 04/21/22.

2021 EM Guidelines: Only for Medicare?

Question:

I work with a surgeon and we see just a few Medicare patients. The surgeon believes the revised 2021 E/M guidelines will not impact our office practice because of our low Medicare volume.

Is this correct?

Answer:

This is not correct and is a common misconception. The revised documentation requirements come from the American Medical Association (AMA) for CPT™. These are the folks that write the codes, not a specific payor.

The changes were essentially agreed to by the Center for Medicare and Medicaid Services (CMS), but they are changes to the code descriptors and guidelines in CPT. One of the primary goals of the change, other than simplification, is standardization. We know that commercial payors and CMS have a variety of documentation standards to support a level of E/M service. Beginning in January 1, 2021, CPT™ has standardized the documentation of the specific level of new and established outpatient visit, which should be applicable to all commercial and government payors.

*This response is based on the best information available as of 04/7/22.

Hartmann or Partial Colectomy

Question:

My surgeon performed all the components of a Hartmann procedure 44143 but did not create a colostomy. Can we use 44143 with a -52 modifier?

Answer:

The correct code for this procedure would be 44140.  Code 44140 is the base code for 44143 with the only difference being a skin level colostomy, so it would be inappropriate to code 44143-52 as there is an established code already in place.

*This response is based on the best information available as of 03/24/22.

Billing for a Wound Vac

Question:

Can you bill for a wound vac on a surgical incision if the patient has a history of incision infections to help prevent this?

Answer:

The AMA published clarification on wound vac billing in the October 2021 CPT Assistant. Negative pressure wound therapy (97605-97606) is considered billable for both open and closed wounds. However, that does not mean that payors will reimburse separately for the service, so use caution and track results.

*This response is based on the best information available as of 03/10/22.