E/M

"An in-patient consultation was done and later on the same day an in-patient surgical procedure was performed. Medicare has paid for the consultation code but has denied payment for the procedure stating that “a CPT or a CPT/modifier combo is not compatible with another procedure or CPT/modifier combo provided on the same day according to the CCI.” The codes used were CPT 99222 and CPT 28820 (T6). Any suggestions?”

“Can you evaluate and manage onychomycosis without debridement for the purpose of treating onychomycosis for an established patient? This would be in the absence of pain and underlying conditions, specifically with Medicare patients. Is it a covered condition for just evaluation and management? Would tinea pedis be covered as a sole diagnosis for evaluation and management?”

“Based on your experience with the new E/M guidelines, is it possible and appropriate for a podiatrist to bill a level 4 or 5 if the documentation is supported? These higher levels have always been taboo (especially level 5). Some patients are at a higher risk with diabetes, chronic non-healing ulcers and wounds etc. Some patients need amputations. Based on the documentation, I believe achieving these higher levels is possible.”

“I am trying to get a handle on the 2021 E/M changes. The question I have is about the defining pathology/diagnosis as “acute” versus “chronic.” This is critical in the portion of the medical decision making. What do the guidelines tell us about these definitions?”