On Demand: Deep Dive Into the 2023 Evaluation and Management Changes-Question and Answer

Question and Answer
Pdf Summary
This Q&A session discusses various coding and billing questions related to evaluation and management (E/M) services in a medical practice setting. Some of the key points mentioned are: <br /><br />- When a general cardiologist refers a patient to an interventionalist within the same practice, the interventionalist may bill a new patient code, but reimbursement may vary among different payers. <br />- If a patient's admission and discharge occur on the same day but more than 8 hours apart, separate documentation is required for both encounters, and a modifier 25 may be used if a separately identifiable E/M service was provided on the date of a procedure such as a heart catheterization. <br />- The attending provider is responsible for billing the discharge service, and only the attending provider and an advanced practice provider (APP) can bill for discharge management. <br />- The designation of hospitalists and general cardiologists as separate providers for consultation purposes depends on tax ID and taxonomy assignments, but generally, hospitalists are usually the admitting providers. <br />- Whether an electrophysiologist would code a sub-specialty care code or an initial visit code (such as 99223) depends on carrier policy and acceptance of the subspecialty assignment. <br />- Multiple providers, such as an emergency room physician and a cardiologist, may bill for an initial emergency visit if the patient stays in the emergency department (ED) setting. <br />- The place of service codes for inpatient and observation services remain the same (21 and 22, respectively), and the corresponding E/M codes (99221-99223 and 99231-99233) can be reported for either place of service. <br />- The 2023 guidelines have aligned the history and exam requirements for inpatient and clinic services, allowing providers to determine the medically appropriate history and exam based on the provider's judgment. The level of service is selected based on medical decision making (MDM) or time. <br />- Only one E/M service can be reported per day for Medicare patients. <br />- The FS modifier is required for split/shared services from a Medicare perspective, but it is recommended to check with other payers regarding their requirements for this modifier. <br />- The physician or qualified healthcare provider (QHP) must perform the exam based on what they deem medically appropriate. <br />- If a condition is documented as stable and no changes are being made to medication, it can be considered addressed if there is sufficient detail in the documentation. <br />- Diagnoses that are not addressed during a visit should not be reported on the claim. <br />- The ICD-10-CM code reported for medication management should correspond to the condition being addressed. <br />- It is recommended to document as much detail as possible, such as specifying the medication for condition management. <br />- Long-term nicotine dependence/smoking may count as a chronic illness depending on the documentation and its impact on other conditions. <br />- Office E/M codes (99202-99215) can still be reported for consultations performed while a patient is admitted to observation status, as per Medicare guidelines. <br />- Time or MDM can be used to determine the level of service when both are documented, and the provider can choose which one benefits them the most. <br />- Split/shared visits apply to hospital-based services, while incident-to guidelines apply to office-based services. <br />- When both a physician and a physician assistant (PA) see a patient at the hospital and no time is documented, the encounter should be billed under the provider who performed the substantive portion of the service (history, exam, or MDM). <br />- If a non-physician practitioner (NPP) documents high MDM and the physician documents the exam, the physician would need to document one key element in its entirety to support the split/shared billing. <br />- The FS modifier is required for split/shared services from a Medicare perspective, but requirements may vary among other payers. <br />- For time-based billing in a graduate medical education (GME) setting, only the time spent by the teaching physician performing qualifying activities should be counted. <br />- Discharge services are time-based and require documentation of the time spent by the provider performing the service. <br />- CMS has a different policy from CPT regarding the use of add-on code 99292 for critical care time, with CMS requiring a minimum of 104 minutes for Medicare patients. <br />- Prolonged services add-ons (99416 and 99418) have multiple unit of service (MUE) assignments for Medicare patients.
Keywords
coding
billing
evaluation and management
E/M services
reimbursement
patient referral
discharge management
electrophysiology
emergency department
Medicare guidelines