Category: Medical Coding

2021 E_M Guidelines FAQ

2021 E/M Guidelines FAQ

AAPC’s senior VP of products answers your questions about coding for office and other outpatient services. Ever since the release of the new 2021 evaluation and management (E/M) guidelines for office and other outpatient services, AAPC has been conducting numerous trainings through webinars, virtual workshops, conference sessions, online courses, and multiple articles in Healthcare Business […]
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FY 2022 ICD-10-CM Codes Now Available

FY 2022 ICD-10-CM Codes Now Available

New codes are effective Oct. 1, 2021. Highly anticipated, the fiscal year 2022 ICD-10-CM codes have been released by the Centers for Disease Control and Prevention (CDC), although still pending are the 2022 Official Coding and Reporting Guidelines which were not included in the package of new codes. We are still waiting for the release […]
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Prolonged Services in CPT versus Medicare

Prolonged Services in CPT versus Medicare

The code 99417 is invalid for Medicare and MA reimbursement. When the CPT® Guidelines were updated for 2021, one of the options for leveling an office or other outpatient evaluation and management (E&M) service was to use time as the leveling agent. The time thresholds for each E&M office visit were also changed from “typical” […]
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CMS Updates Medicare Part B Drug Prices

CMS Updates Medicare Part B Drug Prices

Retroactive code pricing updates may require claims lookback. The Centers for Medicare & Medicaid Services (CMS) has posted a retroactive update to the April Average Sales Price (ASP) pricing file for three Medicare Part B drugs. Also now available are the July ASP and Not Otherwise Classified (NOC) pricing files and the ASP NDC HCPCS […]
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CMS Releases PCS Codes Final Rule

Medical/Legal Impact of 2021 E&M Changes

Without detailed documentation, providers may face an uphill battle in defending themselves from quality audits and even malpractice issues. Up until 2021, at least for the prior two decades, coders and clinicians relied upon the established Evaluation and Management (E&M) guidelines to determine which E&M code was appropriate for each specific encounter. The 1995 guidelines […]
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E_M Coding for 2021_ What’s New and Different

E/M Coding for 2021: What’s New and Different

After three years of policy proposals, the American Medical Association Current Procedural Terminology (CPT) panel responses, and substantial guidance from gastroenterology and other specialty societies, changes to the office/outpatient evaluation and management (E/M) codes became effective as of January 2021. Some aspects of these revisions took effect for telehealth services since spring 2020 for Medicare, […]
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CPT Coding For Excisional Wound Debridement With VAC

CPT Coding For Excisional Wound Debridement With VAC

Q: What CPT codes and modifiers would be used to report excisional debridement for removal of a 2×4-cm ulcer on a patient’s right buttocks with vacuum-assisted closure (VAC)? A: The debridement would be reported using CPT code 11042 (debridement, subcutaneous tissue [includes epidermis and dermis, if performed]; first 20 sq cm or less). This procedure […]
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