The evaluation and management (E/M) code set in the American Medical Association’s Current Procedural Terminology (CPT) book lists descriptors, as well as typical times for patient visits. These times are averages of how long it takes a physician to complete all components of a visit at each level. Because the specific times identified in the…
The American Medical Association (AMA) Relative Value Update Committee (RUC) and Current Procedural Terminology (CPT) meet three times a year to keep the CPT code set up to date and review resource costs for physicians. The two-step meetings of the CPT Editorial Panel and the RUC allow physicians to provide direct input to the Centers…
When the Centers for Medicare and Medicaid Services (CMS) proposed coding and documentation changes to consolidate evaluation and management (E/M) services last fall, the ACR was among many specialist societies actively involved in advocating against the proposed ruling. The changes to E/M coding were part of a larger initiative to reduce the documentation burden on…
A 60-year-old man returns for a follow-up related to his diagnoses of rheumatoid arthritis and chronic gout of his right ankle and foot, without tophi. He reports the gout flares have subsided in his ankle. He takes 450 mg of allopurinol daily. He has rheumatoid factor-positive rheumatoid arthritis, which previously affected multiple sites, without organ…
Take the challenge. CPT: 20611-LT, J7325-EJ ICD-10: M17.12, E66.01, Z68.41 CPT: 99213 ICD-10: M1a.0710, M05.79 History—The history of present illness was extended. The review of systems was extended, and two past family social history elements were documented. This makes the history level detailed. Examination—Five systems were examined. This makes the exam level detailed. Medical decision…
UnitedHealthcare (UHC) announced in the March issue of its Provider Network Bulletin that it will discontinue payment for consultation codes (CPT 99241–99255) later this year. Implementation of the policy will occur in two phases. On June 1, 2019, UHC will eliminate the consultation codes for practices with contracted rates based on a stated year 2010 or…
Join us for the Rheumatology Documentation and Coding Workshop taking place during the 2019 State-of-the-Art Clinical Symposium, Friday, April 5 in Chicago. The Rheumatology Documentation and Coding Workshop will take a deep dive into the new Medicare coding and documentation requirements for evaluation and management coding, medical decision making and specificity in diagnosis coding. Due…
Take the challenge. 1. A—Modifier -25 is defined as a significant, separately identifiable evaluation and management (E/M) service by the same physician or other qualified healthcare professional on the same day of the procedure or other service. It is to be placed on the E/M visit only because it attests to the payer there is…
Which modifier is used when there is a separate and/or identifiable reason to bill for both an evaluation and management code and a procedure code? -25 -24 -51 -59 Which modifier is used to indicate that bilateral procedures were done on a patient? -50 -LT/RT Both a and b None of the above A 68–year-old…
Take the challenge. CPT: 20611-LT, J7325-EJ ICD-10: M17.12, E66.01, Z68.41 Coding/Billing Rationale No evaluation and management (E/M) code was added because there was no significant and/or separate identifiable reason for an E/M service to be billed with this scheduled visit for her series of injections. The joint injection was billed with ultrasound guidance due to…