On Demand: Back to the Basics of CV Coding: Evaluation and Management-Webinar Recording

Video Transcription

Video Summary

Jamie Quimby (MedAxiom) presents a webinar on cardiovascular Evaluation & Management (E&M) coding basics, previewing upcoming education (virtual care, coronary PCI/lower extremity case-driven updates, and a four-part electrophysiology series). Housekeeping includes how to submit questions and download CEU certificates in MedAxiom Academy.<br /><br />Core content reviews medical necessity and how E&M level selection now relies on Medical Decision Making (MDM) or total same-day time (face-to-face plus non-face-to-face). She emphasizes correct place-of-service rules, the “new patient” 3-year rule with cardiology subspecialty designations (often accepted by Medicare, sometimes challenged by commercial payers), and hospital E&M rules based on the current stay. Key Medicare differences include generally allowing only one E&M per calendar day (with limited exceptions such as separately supported critical care), and rules for observation stays (consulting physicians typically bill outpatient E&M codes unless they are the admitting provider). Consult codes remain in CPT but are not paid by Medicare.<br /><br />MDM is explained using the 2-of-3 framework (problems, data, risk). She highlights common cardiology drivers of moderate MDM, documentation pitfalls (listing diagnoses not addressed), and opportunities in data categories (independent interpretation and external discussions). She reviews Medicare’s G2211 “visit complexity” add-on and when it is disallowed (e.g., when modifier 25 is required). Time-based billing and prolonged-service add-ons (including Medicare G-codes) are summarized.<br /><br />A detailed critical care section stresses strict definitions, required time documentation, split/shared rules, and common audit red flags.<br /><br />APP billing is covered: office “incident to” (POS 11 only), facility split/shared with modifier FS, and payer variability. Care management options (CCM, complex CCM, principal care management, TCM, advance care planning) are briefly reviewed. Case examples illustrate correct leveling, missed prolonged billing, and a pacemaker follow-up that should be global rather than an E&M.

Keywords

cardiology E&M coding

Evaluation and Management basics

Medical Decision Making (MDM) leveling

same-day time billing

place of service rules

new patient 3-year rule

Medicare one E&M per day rule

observation vs inpatient E&M billing

consult codes not paid by Medicare

G2211 visit complexity add-on

prolonged services add-on codes

critical care coding requirements

APP incident-to and split/shared billing (modifier FS)