Urology Coding Alert

Stick to the same script despite new 2021 E/M guidance.

Knowing when, or even if, you can code an office/outpatient evaluation and management (E/M) with a minor procedure has always presented challenges across specialties, especially in urology.

You know it’s not as easy as simply appending modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to an E/M visit that occurs in conjunction with a minor surgery, although you will still have to do that in 2021 when the appropriate circumstances apply.

So, has anything changed with modifier 25 use now that the guidelines for the codes have changed? We asked that question to coding expert Lori A. Cox, MBA, CPC, CPMA, CPC-I, CEMC, CGSC, CHONC, and here’s what she had to say.

Straightforward MDM Marks 99202, 99212

The driver in the office visit E/M changes is how you’ll decide between E/M levels: total encounter time or medical decision making (MDM) are the only criteria by which to choose an E/M code now — and you need to pick one or the other. So, you need to make sure you’re lining up your potential separate E/Ms with time or MDM, not the “three key components” of previous years’ E/M coding options (history, examination, MDM). This could be trickier than you think, as Cox illuminated during her presentation at HEALTHCON 2020 Regional Virtual Conference: “E/M Guidelines 2021 — Office Visits With Minor Procedures.”

For example, in order to achieve the straightforward MDM level required for 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 10-19 minutes of total time is spent on the date of the encounter.), Cox reminded coders that the visit must meet two of these requirements: