CHALLENGE #32 — It's YOUR Turn!

Prepare yourself, your staff and your providers for the 2021 E/M changes.

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admin
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Fri Dec 18, 2020 11:19 am

Over the past 31 weeks, we’ve posted a different Challenge question to give you real and practical examples of coding and scoring notes with the 2021 guidelines. With only 2 weeks left before we begin implementing the new guidelines, it’s your turn! Click "Post Reply" in this forum thread and ask your questions or discuss the upcoming changes. Our team will be checking in each day to answer questions. (Each post will still earn an entry into our monthly drawing for a $10 gift card!)
murphma
Posts: 6
Joined: Tue Oct 27, 2020 7:54 am

Fri Dec 18, 2020 12:05 pm

Please clarify what may be counted if a provider orders a lab test at one appointment and then calls the patient on another day to discuss the results or posts the results to the patient's portal? Would this count only as 1 point for the test ordered in conjunction with the appointment and 0 points for the phone call or posting to patient's portal with results on a separate date of service with no appointment?
slswain
Posts: 20
Joined: Tue Jul 17, 2012 11:34 am

Mon Dec 21, 2020 8:43 am

1. I have not read much about the CMS code G2211 - Do you have any specific details/guidance around this code?
2. Would you still advise using the same complexity of care cards for medical necessity or do you feel the MDM chart created by the AMA would mirror the complexity/medical necessity when coding based on MDM? But what about coding based on time? I have not read much on coding based on time AND medical necessity/complexity of care. Thank you!!
jeskla
Posts: 13
Joined: Wed Feb 12, 2020 8:30 pm

Mon Dec 21, 2020 11:54 am

Would I give credit for independent interpretation for both the scenarios below if our office ordered the MRI:

1. The patient had their MRI done 6 months ago by an external source and the physician brought up those images on the screen and states:

Data: MRI of the lumbar spine was again brought up on the screen and reviewed. At L3-4, there is severe spinal stenosis secondary to disk displacement, ligamentum flavum hypertrophy, and facet arthropathy.

My concern is that she has already given her impression of that MRI when the patient first presented to our office now she is reviewing it again by pulling up the images on the screen and giving the results. Does the fact that she already gave her impression 6 months ago change anything? At first I thought I might only give points for review, but she is actually looking at the images again from an external source.

2. The patient had their MRI 2 days ago from an external source. Our office did not order the MRI. The physician pulls the images up on the screen and states:

Data: MRI images reviewed from 12-12-20. At L3-4, there is severe spinal stenosis secondary to disk displacement, ligamentum flavum hypertrophy, and facet arthropathy..
Last edited by jeskla on Mon Jan 25, 2021 8:12 am, edited 1 time in total.
jeskla
Posts: 13
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Mon Dec 21, 2020 12:09 pm

Please clarify the differences in answers regarding risk. In example #28 the risk answer is low for "the ear drops were discontinued."
In example #5 the risk answer is minimal. "ice, elevate Motrin". Assuming the ear drops were over the counter instead of prescription, I don't understand why they both wouldn't be low or both straightforward.
Last edited by jeskla on Sun Dec 27, 2020 7:00 pm, edited 1 time in total.
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admin
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Mon Dec 21, 2020 12:49 pm

murphma wrote:
Fri Dec 18, 2020 12:05 pm
Please clarify what may be counted if a provider orders a lab test at one appointment and then calls the patient on another day to discuss the results or posts the results to the patient's portal? Would this count only as 1 point for the test ordered in conjunction with the appointment and 0 points for the phone call or posting to patient's portal with results on a separate date of service with no appointment?


While the answer to this question was not very clear in the guidelines, we now know based on sessions in the AMA’s 2020 CPT Symposium that ordering a test includes the review, regardless of whether the review happens on the same day or during another subsequent visit. It is 1 point for the ordering, and that’s it.
brownlee47
Posts: 53
Joined: Wed Aug 27, 2014 1:32 pm

Wed Dec 23, 2020 5:17 pm

Webinar MDM part 2, starting at minute 53.38, I don't understand how you were able to get independent historian in low and monderate. in the moderate column we need a combination of the 3 elements where only one was mentioned. What am I missing? The data table is working my nerves.
jeskla
Posts: 13
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Tue Dec 29, 2020 10:12 am

Do you disagree with the risk on the 2021 AAPC coding calculator? https://www.aapc.com/codes/em-calculator-2021/index
It uses the examples in our current risk table.

Minimal


Chest x-rays
EKG/EEG
Urinalysis
Ultrasound, e.g., echo
KOH prep
Rest
Gargles
Elastic bandages
Superficial dressings
Physiologic tests not under stress,e.g.,pulmonary function tests
Low

Non-cardiovascular imaging studies with contrast, e.g., barium enema
Superficial needle biopsies
Clinical laboratory tests requiring arterial puncture
Skin biopsies
Over-the-counter drugs
Minor surgery with no identified risk factors
Physical therapy
Occupational therapy
IV fluids without additives
Other low risk testing or treatment
Prescription drug management
Moderate

Decision regarding minor surgery with identified patient or procedure risk factors
Decision regarding elective major surgery without identified patient or procedure risk factors
Diagnosis or treatment significantly limited by social determinants of health
Physiologic tests under stress,e.g., cardiac stress test, fetal contraction stress test
Diagnostic endoscopies with no identified risk factors
Deep needle or incisional biopsy
Cardiovascular imaging studies with contrast and no identified risk factors,e.g., arteriogram cardiac cath
Obtain fluid from body cavity,e.g., lumbar puncture, thoracentesis, culdocentesis
Therapeutic nuclear medicine
IV fluids with additives
Closed treatment of fracture or dislocation without manipulation
Other moderate risk testing or treatment
Drug therapy requiring intensive monitoring for toxicity
High

Decision regarding elective major surgery with identified patient or procedure risk factors
Decision regarding emergency major surgery
Decision regarding hospitalization
Decision not to resuscitate or to deescalate care because of poor prognosis
Cardiovascular imaging studies with contrast with identified risk factors
Cardiac electrophysiological tests
Diagnostic endoscopies with identified risk factors
Discography
Elective major surgery (open, percutaneous or endoscopic with identified risk factors)
Emergency major surgery (open, percutaneous or endoscopic)
Parenteral controlled substances
Drug therapy requiring intensive monitoring for toxicity
Decision not to resuscitate or to de-escalate care because of poor prognosis
Other high-risk testing or treatment
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