EM Coding Alert

Check out these ob-gyn examples of evaluation and management (E/M) services that may require some finicky coding.

Do you know which codes to select or modifiers to append? Find out.

Question 1: Should You Consider ‘Replacement Codes’ in Consultation Situation?

Your ob-gyn documents a traditional consultation service for a Medicare ob-gyn patient. How should you report this?

Question 2: Do You Know Whether Unlisted Codes are Appropriate?

When a specialist sees a Medicare patient in the hospital at the request of another physician and you know it’s a service that would bill as a consult for a private payer, should you report an unlisted E/M code (99499) for the service, rather than billing an inpatient E/M visit code?

Question 3: Do You Know Who Bills the AI Modifier?

If your physician sees a non-Medicare patient in the hospital at the request of the patient’s attending physician, should you append modifier AI (Principal physician of record) to your claims? And in what scenarios is modifier AI appropriate for Medicare payers?

Question 4: Do You Know What to Check to Justify a Level Transfer?

Suppose your documentation would have supported a level-three outpatient consultation (99243) per AMA CPT^® guidelines for a private payer. Can you simply bill a level-three outpatient visit (99213) for a Medicare patient? Or are level transfers not acceptable?

Click here to find the answers.