Use this decision tree to illustrate Medicare’s rules for coding prolonged E/M services. Medicare created codes and rules for prolonged services performed by a physician or qualified healthcare professional (QHP) because it disagrees with portions of the CPT guidelines.
DecisionHealth, the publisher of Part B News, has revised its tool for office/other outpatient E/M visits (99202-99215) to include encounters performed in the inpatient or observation (99221-99223 and 99231-99236), emergency department (99281-99285), nursing facility (99304-99310) and home or residence (99341-99350) settings and consults (99242-99245 and 99252-99255).
This resource, written by Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, presents a clinical coding scenario and information regarding codes for maternal care for a suspected chromosomal abnormality in the fetus from the 2023 ICD-10-CM code set.
Anatomy and terminology, Hospital outpatient, Questions and answers
The emergency department (ED) is a fast-paced environment that presents unique challenges for coders and billers alike. During this 60-minute webinar, Shelley C. Safian, PhD, RHIA, HCISPP, CCS-P, COC, CPC-I, will explain coding and reporting guidance for common ED procedures and services, such as musculoskeletal injuries, facility E/M coding, burns, and lacerations.
Kimberly Lee, M.Ed., RHIA, CCS-P, answers common questions on the process of querying physicians. These questions were answered during her webinar “Reporting Category III CPT Codes for Cardiology Services and Procedures” on March 30, 2023.
This downloadable PDF offers content on ectopic pregnancy anatomy, treatment, CPT reporting, and a case study. They were created by expert speaker Lori-Lynne WebbCPC, CCS-P, CCP, CHDA, CDIP, COBGC, from her previous HCPro webinar “CPT and ICD-10-CM Coding for Early Delivery and Birth Complications.”
This form focuses on converting the 2022 observation-only E/M codes to the hospital inpatient/observation codes of 2023. This document from NAHRI Journal was originally published in Part B News.
Coding professionals who work in ASC may be familiar with anesthesia modifiers -73 (discontinued outpatient hospital/ambulatory surgery center [ASC] procedure prior to the administration of anesthesia) and -74 (discontinued outpatient hospital/ambulatory surgery center [ASC] procedure after administration of anesthesia). This resource form clarifies instances when these modifiers are appropriate to append.
Modifiers -GX (notice of liability issued, voluntary under payer policy) and -GY (Item or service statutorily excluded, does not meet the definition of any Medicare benefit or, for non-Medicare insurers, is not a contract benefit) tend to cause confusion for many coding professionals. This resource form may be used to clarify when these modifiers are appropriate to append.
