CODING & DOCUMENTATION
Special Edition: E/M Changes
Fam Pract Manag. 2021 Jan-Feb;28(1):35.
Author disclosure: no relevant financial affiliations disclosed.
- PROVIDING E/M SERVICES AND A PREVENTIVE PHYSICAL
- DISCUSSING DATA WITH AN EXTERNAL PHYSICIAN
- WARFARIN MONITORING
- E/M OVER THE PHONE
PROVIDING E/M SERVICES AND A PREVENTIVE PHYSICAL
Do the E/M code revisions change how I should bill when I provide a problem-oriented office visit and a preventive physical on the same day? Can I bill an E/M office visit based on total time, plus a preventive physical exam code? Can I bill an E/M office visit based on medical decision making, plus a preventive physical exam code? Or can I bill only an E/M office visit but increase the total time to include everything?
The code revisions are unlikely to affect how you bill for preventive care services provided on the same date as a problem-oriented office visit. However, when billing a problem-oriented E/M visit based on total time, you must carve out the time spent on separately reportable services. For example, if you spend 30 minutes providing and documenting the preventive service, this cannot be included in your total time for the E/M office visit. Follow CPT guidelines for reporting combinations of preventive and problem-oriented services unless payer policies instruct otherwise.
DISCUSSING DATA WITH AN EXTERNAL PHYSICIAN
In the “data” section of the medical decision making table, category three includes discussion of management or test interpretation with an external physician. Does that mean calling the physician on the date of service, or does making a referral to an external physician count, even if I don't talk to the physician on that day?
The rules for medical decision making are different than the rules for total time. If you are billing based on total time, only the time you spent on the visit on the date of the encounter would count. But if you are billing based on medical decision making, all data related to the visit would count, whether you reviewed it on the day of the visit or not. For instance, you may request a call from a subspecialist on the date of the encounter
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Send questions and comments to firstname.lastname@example.org, or add your comments below. While this department attempts to provide accurate information, some payers may not accept the advice given. Refer to the current CPT and ICD-10 coding manuals and payer policies.
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