E/M Visit During the Global Period

Question:

Can I bill an office visit in the global period if the diagnosis is different from why I did the original procedure?

Answer:

Yes, as long as the diagnosis is not for a related issue (e.g., complication from the original procedure). The documentation must be clear that the condition is unrelated to the original procedure and reflect a clear plan of treatment for the new/unrelated issue. You will then append modifier 24 (unrelated E/M in a global period) to the E/M code.

Incident to Services

Question:

We just recently began hiring PAs to see patient to assist our pain physicians. Our pain doctors want the PAs to see new patients and bill under their NPI number. We see a large population of Medicare patients and I am worried this could get us into trouble.

Answer:

For Medicare patients if the PA sees a new patient the service must be reported under the PA’s NPI number. In order to bill under the physician’s NPI number the patient must be an established patient with an established plan of care. If the patient has a new problem or worsening problem either it must be billed under the PA’s NPI number, or the physician must see the patient on that date of service. If the criteria is met for incident to also keep in mind the physician must be in the office suite and immediately available but does not be in the room.

Question:We have a debate in or office. Our doctors always bill an E/M service with a procedure in the office. For example we had a patient the other day in which the reason for the visit was a trigger point injection. The physician submitted 99213-25 and 20552 for the trigger point. I am new to this specialty, but I was always instructed that if the reason for the visit is the injection, we can only bill the injection. Which is correct?

Answer:
When the reason for the visit is the injection and there is not a significant separately identifiable service then only the procedure is reported (20552) Keep in mind there is an inherent E/M service in every procedure. Any discussion or evaluation related to the injection before the procedure would be considered included in the trigger point preservice time of 11 minutes.

Category III Codes Effective July 1, 2022

Question:

I  heard someone say the 2022 CPT manual will be updated in July with new codes. I have never heard of this before. Is this a rumor or will there be a new CPT Manual released in July?

Answer:

No, there will not be any changes to the 2022 AMA CPT Manual in July.

The following AMA Category III Codes become effective July 1, 2022 and will be identified as new codes in CPT 2023.

Beginning July 1, report the Category III code when appropriate, in place of an unlisted code.

Category III Code	Description	Effective Date	CPT Publication
Ÿ0717T	Autologous adipose-derived regenerative cell (ADRC) therapy for partial thickness rotator cuff tear; adipose tissue harvesting, isolation and preparation of harvested cells, including incubation with cell dissociation enzymes, filtration, washing and concentration of ADRCs Guidelines: Ø (Do not report 0717T in conjunction with 15769, 15771, 15772, 15773, 15774, 15876, 15877, 15878, 15879, 20610, 20611, 76942, 77002, 0232T, 0481T, 0489T, 0565T) ×	7/1/2022	1/1/2023
Ÿ0718T	injection into supraspinatus tendon including ultrasound guidance, unilateral Guidelines: Ø (Do not report 0718T in conjunction with 20610, 20611, 76942, 77002, 0232T, 0481T, 0490T, 0566T)×	7/1/2022	1/1/2023
Ÿ0719T	Posterior vertebral joint replacement, including bilateral facetectomy, laminectomy, and radical discectomy, including imaging guidance, lumbar spine, single segment Guidelines: Ø (Do not report 0719T in conjunction with 22840, 63005, 63012, 63017, 63030, 63042, 63047, 63056, 76000, 76496) ×	7/1/2022	1/1/2023
Ÿ0720T	Percutaneous electrical nerve field stimulation, cranial nerves, without implantation	7/1/2022	1/1/2023
Ÿ0737T	Xenograft implantation into the articular surface Guidelines Ø (Use 0737T once per joint) × Ø (Do not report 0737T in conjunction with 27415, 27416) ×	7/1/2022	1/1/2023

2021 Evaluation and Management Codes: Is a History Required?

Question:

My coder just told me about the new guidelines for 2021 office visit codes. She said I no longer have to document a History. This doesn’t seem right to me.

Answer:

You are wise to ask because that’s not exactly true. It is correct that the History will no longer be used to select a new patient (9920x) or established patient (9921x) visit code. However, it is expected that you will document a “medically appropriate” (per CPT™ history for each encounter.

*This response is based on the best information available as of 06/30/22.

Modifiers on Unlisted Codes. Yes or no?

Question:

Can I use modifiers on an unlisted code?

Answer:

There is not a single right answer to this question. CPT said, in an old CPT Assistant, that generally modifiers are not appended to an unlisted code.

Payors have their own rules. For example, some payors will accept modifier 62 (two surgeons/co-surgery) on an unlisted code such as 64999 while other payors do not.

We would not append modifier 50 (bilateral procedure) to an unlisted code. Your base, or comparison code, should reflect modifier 50 and the associated increase in fee. The same is true for modifier 22.

We also would not append modifier 51 (multiple procedures) to an unlisted code. Let the payor take the discount.

What about global period modifiers such as 58, 78 or 79? It seems reasonable to append those modifiers to the unlisted code.

*This response is based on the best information available as of 06/30/22.

Confusion Regarding the 2021 E/M Guidelines

Question:

The guidelines that came out in 2021 for E/M services is for all types of E/M services, right?

Answer:

No. The 2021 E/M guidelines are for office/outpatient visit codes only (99202-99215). You will still need to use the 1995/1997 guidelines for all other E/M services, even consultations in the office.

*This response is based on the best information available as of 06/30/22.