Wiki E/m section question

[ShinaSharma]

Someone please help me with this question.

A 55-year-old established patient is coming in for a pre-op visit; he is getting a liver transplant due to cirrhosis. The physician performs an expanded problem focused history, detailed examination, and moderate MDM. Patient agrees with his physician's recommendations and the transplantation will take place as scheduled. After the evaluation, the patient expresses a number of concerns and questions for the prospective liver transplant. Physician spends an additional 30 minutes, excluding the time spent in doing the E/M service, in counseling and answering questions regarding the surgery and discussing possible outcomes. What CPT codes should be reported?

A. 99213, 99354

C. 99213, 99358

B. 99214, 99358

D. 99214, 99354
Under code 99354 it's mentioned that don not report with 99214,99213
Then why would we still bill that code with 99354 and same with code 99358

 

[csperoni]

Yes, the possible answers definitely seem based on 1995/1997 guidelines and not 2021 guidelines.
Under the current guidelines for outpatient, you may count all the time spent by the clinician on the date of service and no longer requires counseling/coordination of care > 50% of visit. History and exam are no longer components related to E/M leveling. The exact definition of MDM differs as well.
I don't see the total time noted - only the additional 30 minutes.

With the information presented, we can only count 30 minutes of time. MDM is noted as moderate.
Under 2021 guidelines, I would code this as 99214 only.

 

[jkyles]

Hi there, if the doctor performed an office/outpatient visit you need to apply the guidelines for office/outpatient codes that went into effect Jan. 1, 2021. These visits are coded based on medical decision making or total time on the day of the visit.

The information is in the E/M section of your CPT manual and also available here. https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf

It also contains information about the prolonged service codes.