Inpatient E/M Coding

Question:

I did an inpatient consultation and coded 99253 (non-Medicare). I did not need to follow the patient so I signed off. They asked me to re-consult a week later.  What is the code for a re-consult?

Answer:
There are no specific E/M codes for an inpatient re-consultation.  You’ll use the subsequent hospital care code, 9923x, since it’s the same admission for the patient.

Question:Follow up question: the patient was discharged then admitted a month later and I was consulted again. Is this a subsequent hospital care code?

Answer:
No, since it’s a new admission for the patient, you’ll use the consultation code again (9925x).

Question:Last question: when I see the patient in my office a month later, is it a new patient?

Answer:
No, it’s an established patient (9921x) because you’ve had a face-to-face visit with the patient in the previous 3 years.

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

Takeback to OR

Question:

I had to take a patient back to the operating room 6 weeks after breast reduction to excise a small dehiscence and close the wound. Can I bill for this?

Answer:

Yes, you may bill for the service and you’ll need to use modifier 78 (return to the OR for a related procedure) on your billed code(s). Most payors will reduce your payment by a small percentage (20 – 30%) but you’ll stay in the same 90-day postoperative global period as the breast reduction procedure.

Billing code 36200 with EVAR

Question:

I’m confused about how to code the catheterization with the new EVAR codes. We still do a bilateral catheterization of the aorta. Can we code 36200 bilaterally?

Answer:

The new EVAR codes, updated and completely changed in 2018, bundle the aorta catheterization with the main body placement, so 36200, non-selective arterial catheterization, is no longer separately reported. This is just one of many changes that were made to coding for EVAR.

Use this to facilitate your EVAR/TEVAR and FEVAR coding:

For more detailed information on coding the new EVAR code set, please contact us for a consultation.

Billing Additional Pre-op Visit

Question:

Since we have to bring the patients back in for COVID testing and H&P for Joint Commission, can we bill for this visit even though it’s another pre-op visit?

Answer:

Yes, since the original surgery was canceled and is now under consideration for rescheduling due to the pandemic and needs to be seen for a COVID swab prior to surgery, which is an indication for charging a new visit (as a health status change)

*This response is based on the best information available as of 05/019/22.

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.

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.