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. But good news, the new 2021 guidelines will be used for all E/M codes as of 1/1/2023.

Overreading a Diagnostic Imaging Study

Question:

I sent a patient out to the hospital for a CTA and the patient brought in the actual images and the radiologist’s report for me to review. Can I charge 76140 (Consultation on X-ray examination made elsewhere, written report) when I personally interpret those images and write my own report?

Answer:

No. This code is used by a radiologist who does an overread of an imaging study and provides a written report after reviewing an x-ray exam that was performed elsewhere. Starting in 2021, you receive credit for ordering the CTA at the time of the visit where it was ordered. You do not receive additional E/M credit for reviewing the findings with the patient at a later visit. If however, you did not separately bill for the global or professional component for the reading, you can receive credit for an independent interpretation of the films. This needs to be clearly documented that the images were personally viewed by the provider and the findings of the provider.

Stent and Embolization Coil Used in Same Session

Question:

The surgeon used a stent and then inserted an embolization coil for an aneurysm. Are both billable?

Answer:

If the stent is placed to provide a latticework for deployment of the embolism coil, then no. You would just bill for the embolization. If the stent itself is the sole definitive procedure to treat the aneurysm, then only the stent should be billed.

Billing for Lesion Intervention Crossing Territories

Question:

Our vascular surgeon documented a single intervention for a lesion that crosses the margin between the fem/pop and tibial/peritoneal territories. Should we bill one code or one for each territory?

Answer:

You would bill one code since a single intervention was performed, even though it crossed into another territory.

Angiogram Billing for All Vessels Viewed

Question:

Can we bill for all vessels mentioned if they are documented within the angiogram?

Answer:

No. You should only bill for vessels that are targeted and are medically necessary. Documentation alone doesn’t mean that procedures are always separately billable.

Billing for Vascular Access

Question:

I’m new to vascular coding, can we bill for vascular access for a catheterization? The provider documents this, so I’m thinking I am missing a code.

Answer:

No, vascular access itself is not separately billable with a catheterization. However, the provider must document the vessel accessed , what side of the body, RT or LT y, and the end point of the catheter, so the proper catheterization codes can be billed. Remember, some interventions ( cervico-cerebral angiograms, carotid stenting on the same side as the stenting, and more) include catheterization and it would not be separately billable.