New E and M coding guidelines

[sloh]

Hmm, I don’t understand the safe from audit thing. Why would that be?

If the suggestion is that seeing 40-50 patients per day in clinic would trigger an audit because of volume, I’m doubtful since other specialties like ENT, ortho, and derm get away with it. Consistently billing for the highest level codes in a way that is out of the norm with your peers is a different story.

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[Agast]

My standard A/P template goes:

Blurb about Diagnoses

1. Medications:
2. Studies:
3. Procedures:
4. Rehabilitation:
5. Psychology:
6. Referrals:
7. Follow up:

It allows me to spell out clearly which meds are being started, which ones I’m stopping, a commentary on reviewing imaging results or ordering new ones, the planned procedure, any handouts or formal PT prescribed, urine tox results or comments on anxiety/insomnia/life stressors. I use a lot of smart phrases so it’s fairly quick to hit all the points.

 

[Orin]

Optho's see like 60-80 patients/day in clinic. Ortho seems safe from an audit (from a volume standpoint)

Honestly, ortho is the worst if they're actually billing, but a lot of their stuff falls into the pre/post global period. I would be impressed if they actually started trying to verify how much time based billing people were doing as it isn't realistic for most practices.

 

[jsaul]

The ortho docs in the ortho group i was recruited to saw at least 40 to 50 patients a day. They were all billed 99205 or 99214 or 99215s
They expected me to.see that same volume and thought I was "weak" if I couldn't. It was like a pissing contest.

They didn't think twice about the billing or worry about audits. They just did it

 

[sloh]

Honestly, ortho is the worst if they're actually billing, but a lot of their stuff falls into the pre/post global period. I would be impressed if they actually started trying to verify how much time based billing people were doing as it isn't realistic for most practices.

Yeah time based billing with those volumes would definitely raise some red flags. It's likely they are coding based off medical complexity.

 

[Orin]

Yeah time based billing with those volumes would definitely raise some red flags. It's likely they are coding based off medical complexity.

I think since individual insurers likely don't audit based on other insurer's billing, they don't recognize the abuse of the time billing. You would need to capture every patient to realize that a provider can't be billing for 20 level 5 visits on "time" in an 8 hour day

 

[painfree23]

I think since individual insurers likely don't audit based on other insurer's billing, they don't recognize the abuse of the time billing. You would need to capture every patient to realize that a provider can't be billing for 20 level 5 visits on "time" in an 8 hour day

i feel like that’s easy to catch in modern emrs

 

[sloh]

I think since individual insurers likely don't audit based on other insurer's billing, they don't recognize the abuse of the time billing. You would need to capture every patient to realize that a provider can't be billing for 20 level 5 visits on "time" in an 8 hour day

That’s a very good point. I do a lot of SAR consulting and those of us who do this work routinely see over 40 patients per day. The general consensus is to avoid time based billing since most, if not all, our patients are Medicare A patients. It would be very easy for CMS to catch this.

I’m honestly not sure why anyone would choose to do time based billing. It seems pretty straightforward and easy to document so that your note fulfills criteria for the codes you are billing for through medical complexity. It also confers a lower risk of being audited. All else equal, it seems like the best strategy.

 

[Agast]

Reading through the list of updates:

Final Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2021 | CMS

On December 1, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that includes updates on policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, on or after January 1, 2021.

www.cms.gov

“ In the CY 2021 PFS final rule, CMS is finalizing the proposal to extend the definition of OUD treatment services to include opioid antagonist medications, specifically naloxone, that are approved by Food and Drug Administration under section 505 of the Federal Food, Drug, and Cosmetic Act for emergency treatment of opioid overdose, as well as overdose education. CMS is also finalizing the proposed creation of a new add-on code to cover the cost of providing patients with nasal naloxone and pricing this code based upon the methodology set forth in section 1847A of the Act, except that the payment amount shall be average sales price (ASP) + 0.”

It sounds like it may be possible for us to give patients the narcan kit and be reimbursed, at cost.

 

[myrandom2003]

Level 5 high level of risk:
“Drug therapy requiring intensive monitoring for toxicity”

I’m sure they wanted it to mean something like phenytoin but can’t this also be any opioid? Or if patient happens to be on an opioid and a benzo from someone else?

 

[door_to_balloon_knot]

Level 5 high level of risk:
“Drug therapy requiring intensive monitoring for toxicity”

I’m sure they wanted it to mean something like phenytoin but can’t this also be any opioid? Or if patient happens to be on an opioid and a benzo from someone else?

If coumadin counts, I don’t see why not as long as you write something about how the effects of chronic opiates may cause life-threatening adverse events ¯\_(ツ)_/¯

 

[door_to_balloon_knot]

Level 5 high level of risk:
“Drug therapy requiring intensive monitoring for toxicity”

I’m sure they wanted it to mean something like phenytoin but can’t this also be any opioid? Or if patient happens to be on an opioid and a benzo from someone else?

If coumadin counts, I don’t see why not as long as you write something about how the effects of chronic opiates may cause life-threatening adverse events ¯\_(ツ)_/¯

 

[Agast]

If you weren’t billing level V complexity before for opioid prescribing before, I would hesitate to do it now or at some point you will be investigated for Medicare fraud. I’ve definitely seen people being investigated for upcoding, my guess is these new changes will be too tempting for some and we will see their names in a few years. If you must, I would limit it to your patients who are MED >90.

 

[SommeRiver]

Large ortho group. They underbill in an amazing way.

All NPV are 203 and FU 213.

Documentation is abysmal. Time in room 1 minute. There are times they'll be in with a pt for 30 min though, and that will get a 213 FU.

They REFUSE to read anyone else's notes, and their PAs the same...

Having said that, I'd be fine to let most of them cut me, and we have some very high level surgeons in our group.

...ortho surgery in many cases is voodoo though...

 

[Drd105]

what e&m code would you use in these examples, ignoring the data column:

a) dx: 1) stable b/l knee OA 2) stable lumbar postlaminectomy syn/fusion/spondylosis. plan: rx drug mgt
b) dx: 1) stable lumbar spondylosis/facet OA/LBP 2) stable cervical spondylosis/facet OA/neck pain. plan: rx drug mgt.

Traditionally in this scenario I have billed 99213 (with level 4 HPI and exam) but am wondering based on the discussion here of underbilling if I should be billing 99214. A lot of the time I will not be able to use data to get to 99214 because even if I order UDS and check PMP, I often do not have any other tests appropriate to order, images to interpret or external notes to review.

I cannot find an all-encompassing list of chronic illnesses recognized by Medicare. All I have found is a list of 15 common chronic illnesses recognized by medicare and rheumatoid arthritis/osteoarthritis are the only ones that apply to us.

 

[door_to_balloon_knot]

what e&m code would you use in these examples, ignoring the data column:

a) dx: 1) stable b/l knee OA 2) stable lumbar postlaminectomy syn/fusion/spondylosis. plan: rx drug mgt
b) dx: 1) stable lumbar spondylosis/facet OA/LBP 2) stable cervical spondylosis/facet OA/neck pain. plan: rx drug mgt.

Traditionally in this scenario I have billed 99213 (with level 4 HPI and exam) but am wondering based on the discussion here of underbilling if I should be billing 99214. A lot of the time I will not be able to use data to get to 99214 because even if I order UDS and check PMP, I often do not have any other tests appropriate to order, images to interpret or external notes to review.

I cannot find an all-encompassing list of chronic illnesses recognized by Medicare. All I have found is a list of 15 common chronic illnesses recognized by medicare and rheumatoid arthritis/osteoarthritis are the only ones that apply to us.

Both would be level 4 in my opinion if Rx is actually prescription drug not OTC meds. In addition, you are dressing 2 stable conditions.

 

[Agast]

I’m not opposed to anyone billing that as a 4, but I personally would bill it as a 3 because the next step in management (change nothing/do nothing) does not feel complicated. If I did a Utox that day I might consider it a level 4 because it takes time to review results and act accordingly. I also consider reviewing old images to be relevant, if you did that to reacquaint yourself with the specifics of their anatomy.

 

[Ducttape]

what e&m code would you use in these examples, ignoring the data column:

a) dx: 1) stable b/l knee OA 2) stable lumbar postlaminectomy syn/fusion/spondylosis. plan: rx drug mgt
b) dx: 1) stable lumbar spondylosis/facet OA/LBP 2) stable cervical spondylosis/facet OA/neck pain. plan: rx drug mgt.

Traditionally in this scenario I have billed 99213 (with level 4 HPI and exam) but am wondering based on the discussion here of underbilling if I should be billing 99214. A lot of the time I will not be able to use data to get to 99214 because even if I order UDS and check PMP, I often do not have any other tests appropriate to order, images to interpret or external notes to review.

I cannot find an all-encompassing list of chronic illnesses recognized by Medicare. All I have found is a list of 15 common chronic illnesses recognized by medicare and rheumatoid arthritis/osteoarthritis are the only ones that apply to us.

2 or more stable chronic illnesses and prescription drug management apparently qualifies for level 4 even without review of data.

if you are prescribing opioids, then definitely level 4, because instead of prescription drug monitoring, you are reviewing drug therapy requiring intensive monitoring for toxicity.

 

[myrandom2003]

both level 4... don't feel bad. thats the rules, play by them

 

[clubdeac]

Yeah I agree. Normally I would bill those as a level 3 but according to these new rules, they appear to justify a level 4. What about this example?

Patient returns 3-4 weeks after receiving an L4-5 ILESI. Pain is 40-50% better but still bothersome and limiting requiring periodic NSAIDs and tramadol. After shared decision making, you elect to proceed with a repeat ILESI for added relief.

Assessment: 1) Lumbar radiculopathy - uncontrolled
Plan: 1) Repeat epidural. Risks, benefits, alternatives and expected outcomes discussed

Level 3 or 4?

According to the new guidelines this also appears to be a level 4 in my opinion

Also, based on the new guidelines, does anyone else think billing a level 5 is near impossible now??

 

[lobelsteve]

Saw 79 y/o male s/p L1 kypho 10/18 by me. On Elavil 25mg for sleep. Counseled regarding risks and benefits. Seeing him back in a year, no current pain. Offered in note that if PCP wants to Rx they can.

Level 3?

 

[Ducttape]

club, id guess still level 4 because you are doing med review.

lobel, based on calculator - yes, level 3. 1 stable condition and prescription medication. would still be level 3 if PCP took over.
you do lose the "credit" for meds if someone else is prescribing, apparently... so reviewing someone elses NSAID prescription does not give you points.



level 5 should have always been hard to bill. but technically - i think... a patient on chronic stable opioid medications who comes in with severe exacerbation requiring dose change or urgent procedure or you make the decision to send them to the ER would be a level 5.

in fact, 12 days ago, I saw one patient in active withdrawal, one with history DVT/PE coming in with new onset leg swelling and palpitations, and one patient with suicidal thoughts and a plan. all went to ED. based on new guidelines, i could have billed level 5 for all of them, I guess. but it was Dec. 31st...

 

[Drd105]

thanks very much to all who replied.

clubdeac: I have been using 4 for that because the chronic illness is still "exacerbation, progression" from baseline, though not necessarily progressed since you saw them last, but was on the fence on this one as well.

I have never once billed a level 5 because so colleagues put the fear of God in me to not.

Lobelsteve: I have been using 3 for this.

 

[deleted875186]

Yeah I agree. Normally I would bill those as a level 3 but according to these new rules, they appear to justify a level 4. What about this example?

Patient returns 3-4 weeks after receiving an L4-5 ILESI. Pain is 40-50% better but still bothersome and limiting requiring periodic NSAIDs and tramadol. After shared decision making, you elect to proceed with a repeat ILESI for added relief.

Assessment: 1) Lumbar radiculopathy - uncontrolled
Plan: 1) Repeat epidural. Risks, benefits, alternatives and expected outcomes discussed

Level 3 or 4?

According to the new guidelines this also appears to be a level 4 in my opinion

Also, based on the new guidelines, does anyone else think billing a level 5 is near impossible now??

just had a meeting with the hosptial coder.

Hard to get to level 4 based on ordering tests, the reason is because you cannot count a test twice. So even if I reviewed the old MRI again and correlate it with their symptoms, say maybe patients symptoms have changed and that high canal stenosis seems like it may be the problem, I already “counted” that imaging test back when I ordered it in my medical decision. Apparently you cannot double dip, you get the credit once when you order the test, or when you interpret it, and then that’s it. Seems screwed to favor medical specialist who do labs. Our physical exam maneuvers are not tests, our results of injections are not diagnostic tests, and as mentioned only a new image counts as a test.

planning for an injection counts as “moderate risk”, same category as a “minor procedure”, and so if risks and benefits were discussed with the patient can get you to a level 4, so long as there are two chronic illnesses etc that fufuill the first medical complexity bucket. This way you can get past having to do the “test, orders, lab” etc to get to a level 4.

 

[deleted875186]

If anyone has any recs from their hospital coder please share

 

[myrandom2003]

If you prescribe any medication, That’s moderate.

If you have two stable illinesses such as dorsalgia, spinal stenosis with clarification, that’s a level 4

If you have one chronic back pain with exacerbation and you prescribe a med, that’s a 4.
If you have chronic back pain exacerbation, look at recent labs to evaluate for possible infection, CBC Esr crp that’s three labs. That’s a 4, exacerbation and an Rx that’s a 4.

Review you any referral note, order mri or review mri independently and glance at a lab, order a med, that’s a 4.

It’s not hard at all.
Just have to justify.
And it’s not fraud. Confirmed with hospital coder. They have access to other cpt books and edits etc.

Right now it’s still not clearly explained so if you can justify without reaching, it’s all good.

 

[SSdoc33]

Bill a 4 if you do something. Bill a 3 if you dont

 

[clubdeac]

just had a meeting with the hosptial coder.

Hard to get to level 4 based on ordering tests, the reason is because you cannot count a test twice. So even if I reviewed the old MRI again and correlate it with their symptoms, say maybe patients symptoms have changed and that high canal stenosis seems like it may be the problem, I already “counted” that imaging test back when I ordered it in my medical decision. Apparently you cannot double dip, you get the credit once when you order the test, or when you interpret it, and then that’s it. Seems screwed to favor medical specialist who do labs. Our physical exam maneuvers are not tests, our results of injections are not diagnostic tests, and as mentioned only a new image counts as a test.

planning for an injection counts as “moderate risk”, same category as a “minor procedure”, and so if risks and benefits were discussed with the patient can get you to a level 4, so long as there are two chronic illnesses etc that fufuill the first medical complexity bucket. This way you can get past having to do the “test, orders, lab” etc to get to a level 4.

Hold up so are you saying if I read/interpret a patient’s MRI on his 1/12/21 visit I can never do that again on future visits to justify a level 4? That seems really messed up

 

[NOSfan]

If anyone has any recs from their hospital coder please share

Attached is some time-based information

 

[mid|ine]

"Hard to get to level 4 based on ordering tests, the reason is because you cannot count a test twice"

Show me where this is written. The criteria focus on medical decision making. If you are deciding to order a test that is different then interpreting and using the results of a test. And if you go back later to make a new decision that seems that would count again. IE, patient has lumbar radic, MRI shows disc buldge at L4-5, ESI is done, radic improves but axial back pain persists. MRI is re-reviewed and shows spondylosis and MBBs are planned

I also think that you can justify neuroaxial interventions at a higher risk then a large joint or other "minor procedure"

Opioid medication management and monitoring can clearly fall under complex decision making

 

[gaseous_clay]

According to these attached charts, the biggest challenge to billing a 99213 is the amount of data/complexity of column, which needs the following to get to “limited” category:

Category 1 Tests and documents (2 out of 3)
1. Review of prior external notes from a unique source
2. Review of results of each unique test
3. Ordering of each unique test

OR
Category 2: Assessment requiring an independent historian

It will be difficult to satisfy category 2 so I imagine under category 1, looking at the PMP will take care of #1 and ordering/reviewing a UDS/imaging study will take care of #2 and #3.
I don’t see how one can bill out a level 3 on a routine follow up in which your aren’t doing numbers 1, 2, and/or 3 under category 1 regardless of the number and complexity of problems and risk of complications of patient management. Am I missing something here?

 

[myrandom2003]

"Hard to get to level 4 based on ordering tests, the reason is because you cannot count a test twice"

Show me where this is written. The criteria focus on medical decision making. If you are deciding to order a test that is different then interpreting and using the results of a test. And if you go back later to make a new decision that seems that would count again. IE, patient has lumbar radic, MRI shows disc buldge at L4-5, ESI is done, radic improves but axial back pain persists. MRI is re-reviewed and shows spondylosis and MBBs are planned

I also think that you can justify neuroaxial interventions at a higher risk then a large joint or other "minor procedure"

Opioid medication management and monitoring can clearly fall under complex decision making

It is explained, I will find and post the link.
These guidelines were not geared towards us.
The explanation I read dealt with X-rays and blood work but it would apply to any imaging.
You get credit for ordering the image/lab/diagnostic test but no credit for bringing the patient back to review. You are not allowed to double dip. Again, I will find it and post link.

I believe the asterix would be for an imaging study, you can order a radiology test once and get credit and also get credit for independent interpretation once.

 

[gaseous_clay]

The other issue is a lot of commercial insurance plans don’t follow this new E/M coding system as yet. So are we supposed to have two different methods of coding based on government vs nongovernmental payors?

 

[deleted875186]

"Hard to get to level 4 based on ordering tests, the reason is because you cannot count a test twice"

Show me where this is written. The criteria focus on medical decision making. If you are deciding to order a test that is different then interpreting and using the results of a test. And if you go back later to make a new decision that seems that would count again. IE, patient has lumbar radic, MRI shows disc buldge at L4-5, ESI is done, radic improves but axial back pain persists. MRI is re-reviewed and shows spondylosis and MBBs are planned

I also think that you can justify neuroaxial interventions at a higher risk then a large joint or other "minor procedure"

Opioid medication management and monitoring can clearly fall under complex decision making

This is what was told to me from the hosptial coder.

I asked specifically about MRI, PMP, Utox, whether or not interpretation of an ESI or MBB counts as a “test” if we review how the ibr ruin worked.

If other peopke got different info from the coders please share.

 

[paindoc007]

I heard the same thing. Sounds insane. Apparently you’re not supposed to even bill a followup mri review office visit??

FAQ: Scoring Elements in the E/M Guidelines

Scoring data elements can be challenging. This FAQ covers data, using time, social determinants of health and more

codingintel.com

 

[deleted875186]

I heard the same thing. Sounds insane. Apparently you’re not supposed to even bill a followup mri review office visit??

FAQ: Scoring Elements in the E/M Guidelines

Scoring data elements can be challenging. This FAQ covers data, using time, social determinants of health and more

codingintel.com

Just means you cannot count MRI as a “test” on the subsequent visit.

I imagine it goes like this

1. Initial visit, order MRI or X-RAY, document review of PCPs notes, some other “test” or fluff. This will get you to moderate complexity along with two chronic illnesses, one with an exacerbation.

2. follow up, use risk to get you to level 4. Reviewed risk of LESI, treatment options discussed, risk of procedure, this along with the 2 illnesses and an exacerbation will get you a level 4 follow up.

What if no injection, simply replace LESI with whatever medication your titrating, gaba, opioid, change to a different NSAID. Or, they also let you bill for medical complexity even if patient doesn’t want to do an injection or procedure, just put in note discussed option of LESI and risks and benefits, still counts as same complexity of MDM.

may least that’s how I understand it

 

[clubdeac]

Reading/interpreting your own MRI or X-rays regardless of what happened in past visits would count as a level 4

scheduling a neuraxial procedure and discussing the risks , benefits alternatives etc. should be a level 4

prescription Med management is a level 4

one chronic illness with exacerbation is a level 4

seems pretty easy to get a level 4

 

[Multimodal]

Reading/interpreting your own MRI or X-rays regardless of what happened in past visits would count as a level 4

scheduling a neuraxial procedure and discussing the risks , benefits alternatives etc. should be a level 4

prescription Med management is a level 4

one chronic illness with exacerbation is a level 4

seems pretty easy to get a level 4

maybe im late to the party here but how does one chronic illness with exacerbation alone get a level 4? I thought we needed 2 of the 3 components of medical decision making. the chronic illness with exacerbation alone gets 1/3 MDM components but dont we need either increased complexity OR risk ?


what about a patient who I refer to another specialist (spine or ortho) or for PT at the f/u for an injection? Im having trouble justifying this as a level 4 since I cant seem to get enough bullets in the complexity column and if I am not managing any medications, to me it seems like these visits are solidly level 3?

glad everyone here is having as much fun with the coding transition as I am!

 

[deleted875186]

maybe im late to the party here but how does one chronic illness with exacerbation alone get a level 4? I thought we needed 2 of the 3 components of medical decision making. the chronic illness with exacerbation alone gets 1/3 MDM components but dont we need either increased complexity OR risk ?


what about a patient who I refer to another specialist (spine or ortho) or for PT at the f/u for an injection? Im having trouble justifying this as a level 4 since I cant seem to get enough bullets in the complexity column and if I am not managing any medications, to me it seems like these visits are solidly level 3?

glad everyone here is having as much fun with the coding transition as I am!

This is my understanding as well, the 2 chronic illnesses and one exacerbation is just 1 out of 3 columns required to reach a level 4 visit.

my understanding is the easiest way for us to get there is with risk. Document that you considered a LESI, or an MBB, or any other injection or invasive procedure, even if you are opting to try PT first or gaba, or an NSAID, or wait for a neurosurgical eval. Just considering an injection gets the risk to a moderate level.

 

[Laryngospasm]

Aim for the sky let the audits sort it out 😂 In all seriousness do your best and I err on the side of over billing. If you see 60pts a day then err on the side of underbilling.

 

[clubdeac]

maybe im late to the party here but how does one chronic illness with exacerbation alone get a level 4? I thought we needed 2 of the 3 components of medical decision making. the chronic illness with exacerbation alone gets 1/3 MDM components but dont we need either increased complexity OR risk ?


what about a patient who I refer to another specialist (spine or ortho) or for PT at the f/u for an injection? Im having trouble justifying this as a level 4 since I cant seem to get enough bullets in the complexity column and if I am not managing any medications, to me it seems like these visits are solidly level 3?

glad everyone here is having as much fun with the coding transition as I am!

Yes sorry, to clarify you still need to meet 2 out of 3 categories. I meant that each example above reaches a level 4 in its respective category

 

[Drd105]

I heard the same thing. Sounds insane. Apparently you’re not supposed to even bill a followup mri review office visit??

FAQ: Scoring Elements in the E/M Guidelines

Scoring data elements can be challenging. This FAQ covers data, using time, social determinants of health and more

codingintel.com

great link thank you

 

[clubdeac]

I heard the same thing. Sounds insane. Apparently you’re not supposed to even bill a followup mri review office visit??

FAQ: Scoring Elements in the E/M Guidelines

Scoring data elements can be challenging. This FAQ covers data, using time, social determinants of health and more

codingintel.com

I completely disagree with some of this coder's interpretation. I have read the actual verbiage and believe this person is misinterpreting the guidelines. Just b/c I order an MRI at one visit doesn't mean I don't get credit for reviewing it with the patient at the next visit. Reviewing it alone qualifies as a level 4 within the data category. Simply ordering an MRI only counts as one data point of which you must obtain 3 to qualify as a level 4. So the two hold entirely different weight

The AMA in describing the the rules states you can't order something like a lumbar X-ray and then interpret it on the same visit and have that count as 2 data points. That is "double dipping". You also can't include MRI interpretation as your level 4 data point if someone in your practice separately billed for interpreting the imaging. Lot's of spine guys used to do this. They'd bill for interpreting their own X-rays at the same time as a level 3 or level 4 office visit. Those are the two examples the AMA uses to describe "double dipping"

 

[Drd105]

I completely disagree with some of this coder's interpretation. I have read the actual verbiage and believe this person is misinterpreting the guidelines. Just b/c I order an MRI at one visit doesn't mean I don't get credit for reviewing it with the patient at the next visit. Reviewing it alone qualifies as a level 4 within the data category. Simply ordering an MRI only counts as one data point of which you must obtain 3 to qualify as a level 4. So the two hold entirely different weight

The AMA in describing the the rules states you can't order something like a lumbar X-ray and then interpret it on the same visit and have that count as 2 data points. That is "double dipping". You also can't include MRI interpretation as your level 4 data point if someone in your practice separately billed for interpreting the imaging. Lot's of spine guys used to do this. They'd bill for interpreting their own X-rays at the same time as a level 3 or level 4 office visit. Those are the two examples the AMA uses to describe "double dipping"

I am in an ortho group wasn't aware of the second sentence in your second paragraph...

Are you saying if one of the ortho guys in my group orders an MRI (our internal MRI), their MRI f/u visit will use category 2 'independent interpretation', and if I see the patient after them (referral for ESI) I am only allowed to use one category 1 data point to "review the results of...test" and I cannot use independent interpretation of test?

*OR* are you are talking about an ortho charging for the CPT code for the xray and also charging for 'independent interpretation' ?

I should also add that if an ortho is capable of billing insurance for an xray CPT code and then also billing for a pseudo-radiologist read then I was not aware they could do that...but now I'm wondering if that's what you meant.

 

[jsaul]

man so much effort debating back and forth over nabbing that extra 30 dollars going from 99213 to 99214. it really shows how pitiful this system is,
you think orthos are debating this like you guys are> they are just going to bill 99214 and the hell with it

 

[afob100]

Since the time based billing now includes time you spend non-face to face.. it seems much easier to get to 30 minutes for 99214? Honestly, how would they ever know how much time you actually spent? You could go home and "work on their note" each night which counts. Any of your time spent on the day of the visit counts to the 30 min.

 

[Drd105]

man so much effort debating back and forth over nabbing that extra 30 dollars going from 99213 to 99214. it really shows how pitiful this system is,
you think orthos are debating this like you guys are> they are just going to bill 99214 and the hell with it

You're right about that. In general think that my opioid prescribing and ortho's lack thereof puts me more at risk for audit so I am trying to GIVE IT my best effort.

 

[ateria radicularis magna]

Don’t forget OBESITY is a chronic and very serious problem and is almost always strongly related to pain. “Counseled the patient today with specific dietary and exercise strategies. Recommend calorie count and limiting carbohydrates.”
As long as the patient is obese then that patient is not meeting the goal of attaining a healthy body weight, and is therefore not “stable.” Now back to medial branch evangelism.

 

[clubdeac]

I am in an ortho group wasn't aware of the second sentence in your second paragraph...

Are you saying if one of the ortho guys in my group orders an MRI (our internal MRI), their MRI f/u visit will use category 2 'independent interpretation', and if I see the patient after them (referral for ESI) I am only allowed to use one category 1 data point to "review the results of...test" and I cannot use independent interpretation of test?

*OR* are you are talking about an ortho charging for the CPT code for the xray and also charging for 'independent interpretation' ?

I should also add that if an ortho is capable of billing insurance for an xray CPT code and then also billing for a pseudo-radiologist read then I was not aware they could do that...but now I'm wondering if that's what you meant.

I'm talking about an ortho charging for the CPT code for the xray and also charging for 'independent interpretation

 

[myrandom2003]

Don’t forget OBESITY is a chronic and very serious problem and is almost always strongly related to pain. “Counseled the patient today with specific dietary and exercise strategies. Recommend calorie count and limiting carbohydrates.”
As long as the patient is obese then that patient is not meeting the goal of attaining a healthy body weight, and is therefore not “stable.” Now back to medial branch evangelism.

This is very true. And I use this often. Obesity is never stable.

Take it from someone that is also boarded by the American Board of Obesity Medicine.
Sadly, unless your a primary care IM/FP, surgeon, or a NP/PA, Medicare and some commercials ins do not recognize other specialists to address or treat treat obesity. So I just talk about obesity as a secondary diagnosis. Have passed every internal audit.