2021 E/M Coding Guidelines

Question:

In the 2021 E/M revision guidelines, how does Time affect billing for a teaching physician’s E/M service when the resident spends a great deal of time with the patient?

Answer:

Good question! Only the time of teaching physician would “count” in the scenario you describe. The new guidelines say that the time of the physician or other qualified health care provider (QHP) are considered. A QHP is a licensed credential provider of E/M services such as a Physician Assistant, Nurse Practitioner or Clinical Nurse Specialist…not a resident. Therefore, we cannot add, or consider, the amount of time the resident spent with the patient.

Stent vs. Embolization or Both

Question:

If the surgeon uses a covered stent and performs an embolization on a patient with a pseudoaneurysm, can we bill for both the stent and removal of the embolus?

Answer:

If a covered stent is deployed as thesolemanagement of an aneurysm, pseudoaneurysm or vascular extravasation, then thestent deploymentshould be reported and not the embolization code.

Dialysis Circuit Revision

Question:

My vascular surgeon performed a dialysis circuit open revision, and had to remove subcutaneous fat during the procedure. He said this was a more complex procedure than usual, so is there another code to use besides 36832?

Answer:

Removing excess subcutaneous fat is included in the work for 36832, so this is the only appropriate code for an open revision without a thrombectomy.

Billing Separately for Diagnostic Angiograms

Question:

Our surgeon performed an aortogram with run-off to bilateral lower extremities. He then performed interventions in the left SFA and the left peroneal arteries. My question is regarding documentation of the diagnostic imaging Can he also bill for a diagnostic angiogram? What about catheterization to get there?

Answer:

Diagnostic imaging during lower extremity arterial revascularization procedures such as stent and atherectomy, may be separately billed at the same session as the intervention when:

• no previous diagnostic study is available,
• the prior study(ies) do not adequately to diagnose the disease or
• the patient’s condition changed either since the last study or during the procedure

Although CPT considers only catheter- based angiograms as a prior study, Medicare considers a CTA to be a prior diagnostic study. Catheterization is always bundled with lower extremity arterial interventions, including angioplasty, stenting or atherectomy.

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.