E/M

“I saw an established patient who returned to the office for Routine Foot Care. The patient also had a new complaint of heel pain. I obtained X-rays of the foot and gave a steroid injection into the heel. Can I bill for the Routine Foot Care and those treatments as well?”

“Medicare pays approximately $40 more for an E/M 99213 versus an injection for a neuroma injection. Can you give the injection and only bill the E/M 99213?”

“My group takes “call” at our local hospital, and this necessitates seeing patients in the emergency room (ER) on occasion. We are not all in agreement regarding what E/M codes should be used in this scenario. We have come up with different encounters: 1. A patient seen in the ER. The patient is then discharged to follow up for outpatient care. 2. A patient is seen in the ER and then admitted for continued medical treatment. 3. A patient is seen in the ER and is taken straight to the operating room for surgical treatment. What E/M code series would you recommend using for these different scenarios? Thank you for the help!”

“After watching some E/M presentations, it was suggested that hospital consultations should be billed with CPT 99252-CPT 99255. When we billed these codes, our EMR system and our clearing house rejected the codes. They are saying effective 1/1/2010, CMS has announced that they will reject these codes. Are we billing the right codes?”

“I am not sure when I should and can bill for an E/M when seeing patients for wound care. Is it reasonable to bill an E/M code if the patient returns for follow up for their ulcer and it is 100% healed? Occasionally hyperkeratotic tissue is present and sometimes I debride the callus to confirm the ulcer has healed. I always spend time on these visits educating the patient on ulcers and the diabetic foot. Would it be appropriate to code for an E/M at this visit since the vast majority of the time is spent counseling the patient prior to discharging them from care?”

“How do you code for a hospital consultation when the patient is in the postoperative global period from another surgeon? I was called to the local hospital to see a patient that was transferred for medical treatment for an unrelated condition. He had a transmetatarsal amputation (TMA) performed for apparent osteomyelitis at the other hospital by a different podiatric surgeon. I was consulted to evaluate the TMA site and make recommendations for management. How do I code the diagnosis and E/M for this post-operative consultation?”

“I saw an established patient who returned to the office for “At Risk,” Routine Foot Care. The patient also had a new complaint of heel pain. I obtained X-rays of the foot and gave a steroid injection into the heel. Can I bill for the “At Risk,” Routine Foot Care and those additional treatments as well?”

Part I: What are the coding documentation guidelines for Level 4, specifically 99204 and 99214 using Medical Decision Making? Part 2: What level of E/M service does the treatment of a paronychia qualify for?

When selecting the level of E/M service based upon medical decision-making, the best source of information is the Level of Medical Decision-Making Table. The table includes the four levels of medical decision making (ie, straightforward, low, moderate, high) and the three elements of medical decision making (ie, “number and complexity of problems addressed,” “amount and/or complexity of data reviewed and analyzed,” “and risk of complications and/or morbidity or mortality of patient management”). To qualify for a particular level of medical decision making, two of the three elements for that level of medical decision making must be met or exceeded. It is under “Number and/or Complexity of Problems Addressed” that the issue of acute versus chronic is addressed. Acute versus chronic is not based upon a “time frame.”

If a patient that has Traditional Medicare and a secondary coinsurance, when, if ever, is it appropriate or is it payable to bill for a consultation code such as CPT 99243 or CPT 99244?