Coding and Reimbursement Basics for the Interventionalist-Evaluation and Management 2021 Guidelines

Evaluation and Management 2021 Guidelines

Pdf Summary

The Evaluation and Management (E/M) Guidelines for 2021 provide information on the CPT codes, risk factors, amount/complexity of data, and time associated with different levels of evaluation and management services.<br /><br />The CPT codes, such as 99202/99212, 99203/99213, 99204/99214, and 99205/99215, are categorized based on the level of risk involved in additional diagnostic testing or treatment. For example, 99202/99212 have minimal risk, while 99205/99215 have high risk.<br /><br />The amount/complexity of data and risk factors associated with each CPT code are also considered. For instance, 99202/99212 is for self-limited or minor problems with minimal or none data. 99203/99213 includes 2 or more self-limited or minor problems with moderate risk. 99204/99214 involves 1 or more chronic illness with exacerbation or side effects of treatment, and 99205/99215 deals with chronic illnesses with severe exacerbation or side effects.<br /><br />The CPT code time frames vary for each level of service. For example, 99202 is for 15-29 minutes, while 99205 is for 60-74 minutes.<br /><br />There are commonly used modifiers, such as 25 (distinct E/M), 59 (distinct and separate procedures), 95 (telehealth service), 22 (unusual circumstances), 24 (E/M unrelated to previous surgery), 78 (return to operating room related to previous surgery), and 79 (return to operating room unrelated to previous surgery).<br /><br />Overall, the guidelines provide a structure for healthcare providers to accurately document and code their evaluation and management services based on the level of risk, amount/complexity of data, and time involved.

Keywords

Evaluation and Management Guidelines

CPT codes

risk factors

amount/complexity of data

time associated

evaluation and management services

diagnostic testing

treatment

modifiers

healthcare providers