American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Office Procedure and E/M Coding

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Learning Objectives

As a result of this course, participants will be able to:

  • Recognize the E/M office visit coding changes for 2021
  • Demonstrate accurate coding of E/M office and hospital visits in 2020
  • Identify appropriate use of modifiers with E/M services
  • Describe the components of the global surgical package, including critical care rules
  • Demonstrate accurate coding of biopsies, FNA, excisions, and laceration repair
  • Differentiate coding for screening versus diagnostic colonoscopy
  • Apply teaching physician rules and coding for services
  • Describe accurate coding of telemedicine, eVisits, consults, and non-face-to-face services
  • Implement practice management strategies for collecting from patients with high-deductible health plans.

What's on the Agenda

E/M Office Coding Changes in 2021

  • Code definition changes for 99202-99215
  • New rules for using time for office and outpatient visits
  • New medical decision-making grid in 2021
  • Recommended changes to templates for next year

E/M Office and Hospital Coding in 2020

  • Select accurate codes for hospital and office services based on medical necessity and documentation
  • Know what shortcut phrases are supported by the Documentation Guidelines and what phrases to avoid
  • Medical decision making in its current form
  • Know when using time is the winning hand

Selecting the Correct Category of Code

  • New and established patient visits and consults
  • Select the correct category of code for initial inpatient services, regardless of payor
  • Coding for visits in the emergency department

Global Surgical Package

  • Components of the global surgical package
  • Separately reportable E/M services
  • Modifiers 24, 25, and 57
  • Differences between the CMS and CPT definitions of the global package

Critical Care

  • Critical care coding rules in and out of the global package
  • Trauma teams and critical care

Surgical Procedures Commonly Done in the Office

  • Biopsies, excisions, fine needle aspiration
  • Laceration repair

Screening Colonoscopy

  • Append the correct modifiers to screening colonoscopy services
  • Determine the primary and secondary diagnosis codes

Working in Teams with Residents, NPs, and PAs

  • Update to teaching physician rules for students and residents
  • Medicare incident to and shared services rules

Telemedicine: Separating the Hype from the Reality

  • Telemedicine as defined by Medicare
  • Place of service and modifiers for telemedicine
  • New CPT codes for online digital E/M
  • Interprofessional consults
  • Non-face-to-face prolonged services

Practice Management

  • CMS policy update
  • Key A/R metrics
  • Surgical deposits and point-of-service collections
  • Denial management