On Demand: Back to the Basics of CV Coding: Evaluation and Management-Presentation Slides

Presentation Slides

Pdf Summary

This March 26, 2026 MedAxiom webcast, “Back to the Basics of CV Coding: Evaluation & Management,” reviews core E/M coding concepts for cardiovascular practices, with emphasis on medical necessity, correct place of service, and selecting code levels by either medical decision making (MDM) or total time on the date of the encounter. It shares cardiology “bell curve” utilization patterns for common office, inpatient/observation initial, and subsequent visit codes, noting that unusually high or low leveling may signal undercoding, upcoding risk, or documentation gaps.<br /><br />Key guidance includes defining “new patient” differently by setting (3-year rule for office; “during current stay” for facility initial services) and clarifying AMA vs CMS misalignment for reporting E/M when a patient is admitted from another site on the same date (AMA allows separate reporting with modifier 25; CMS typically limits to one E/M per date). Discharge coding is reviewed (99238/99239) and same-day admit/discharge rules (99234–99236 and when to use initial hospital codes for <8-hour stays). ED E/M remains MDM-based without time as a leveling factor.<br /><br />The presentation breaks down the MDM table (problems, data, risk), including “data” counting rules and documentation reminders (problem lists alone don’t support MDM). It clarifies that prescription drug management requires active management, not merely reviewing a med list, and defines “drug therapy requiring intensive monitoring for toxicity.” It also discusses add-on code G2211 (visit complexity/longitudinal relationship) and that it cannot be billed when modifier 25 is used.<br /><br />Time-based reporting is contrasted with older rules; prolonged-service coding differs between CPT and CMS (including Medicare G-codes). Critical care billing is reviewed: it requires a critical condition, critical treatment, and documented time (99291/99292), with guidance on split/shared critical care and audit-focused documentation tips.<br /><br />APP billing options are summarized (APP-only, incident-to in POS 11 only, and split/shared with substantive portion and modifier FS). Finally, care management options (CCM, complex CCM, PCM, TCM, advance care planning) are outlined with general eligibility and time requirements, reinforced through multiple real-world coding case examples.

Keywords

E/M coding

cardiology practice coding

medical decision making (MDM)

total time billing

place of service (POS)

new patient definition

modifier 25

hospital discharge codes 99238 99239

critical care billing 99291 99292

APP split/shared billing modifier FS