Please respond to at least 2 of your peer’s posts with substantive comments using the following steps:
- Substantive comments add to the discussion and provide your fellow students with information that will enhance the learning environment.
- References and citations should conform to APA standards.
- Remember: Please respect the opinions of others, even if their views differ. In other words, disagree professionally and respectfully.
Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the student’s position.
Please be sure to validate your opinions and ideas with in-text citations and corresponding references in APA format.
On January 1, 2021, changes were implemented to the E/M codes for evaluation and management of patients in outpatient settings as well as to the CPT codes for current procedural terminology. With this change, providers have the flexibility to focus their coding on the medical decision-making process and report the duration of the encounter, rather than incorporating the evaluation and history criteria. To simplify the process of documenting office visits, the process was changed (The Centers for Medicare & Medicaid Services, 2021).
This patient is a new patient who presents for the establishment of care and to manage acute and chronic problems.
CPT E&M Code: 99205
- The chronic problem ( Depression) getting worsening =2
- New Problem ( suicidal ideation with plan) Additional Workup (referral) – 1 = 4 points
- New Problem ( Vitamin B deficiency) No Additional Workup – max 1 = 3 points
- Total Points = 9
- Greater than 4 points = Extensive
Amount/Complexity of Data Reviewed =
- Review Labs = 1 point
- Total Points = 1
Risk of Complications, Morbidity, or Mortality
- High – Threat of suicide with plan and thoughts puts this patient at a high level.
Due to the above reasons, the medical decision would be considered to be of high complexity. A chronic condition that has progressed due to suicidal thoughts, resulting in a threat to the patient’s life. An increased risk of suicide is deemed to be a “high” level of Medical Decision Making by the American Medical Association (2021).
American Medical Association. 2021. CPT Evaluation and Management (E/M). https://www.ama-assn.org/system/files/2019-06/cpt-…
The Centers for Medicare & Medicaid Services. (2021). Evaluation and Management Services Guide. https://www.cms.gov/Outreach-and-Education/Medicar…
CPT E&M Codes: 99205 Office Visit, New patient, Level 5
Rationale for the above code:
There are three categories of Medical Decision Making which are Diagnoses/Management options, amount/complexity of data reviewed and risk of complications, morbidity or mortality. American Medical Association (AMA): CPT Evaluation and Management (E/M) Office or Other Outpatient (99202-99215) and Prolonged Services (99354, 99355, 99417) Code and Guideline Changes, 2021):
# of diagnoses/Management options
- New Problem No Additional Work up = 3 points
- New problem, additional work up plan = 4 points
- Total Points = 7points
- Greater than 4 points Extensive
This is a new patient with prediabetes, Vitamin B12 deficiency, depression with suicidal ideation. A total of four points, which qualifies as “high” complexity in the diagnosis and management component.
Amount/ complexity of data reviewed
- Review labs = 1 point
- Total point = 1 point
- 0-1 point = minimum
The review of laboratory test of fasting glucose and vitamin B12 results
Risk of complication, morbidity or Mortality
Risk level =high
Risk of complication is high due to a psychiatric illness with potential threats to self. He has a plan and the means ( using a rifle gun)
Per American Academy of Professional coder (AAPC) the American medical Association developed new guidelines and code descriptors for office and outpatient E/M codes which took effect last January 1 ,2021. In the 2021 MDM guidelines includes establishing diagnoses, assessing the status of a condition and/or selecting a management option.
The three elements define MDM for office/outpatient visits in 2021 are:
- The number and complexity of the problem or problems the provider addresses during the E/M encounter.
- The amount and/or complexity of data to be reviewed and analyzed. The 2021 guidelines list three categories for data: (1) tests, documents, orders, or independent historians, (2) independent test interpretation, and (3) discussion of management or test interpretation with external providers or appropriate sources. The latter term refers to non-healthcare, non-family sources involved in patient management, like a parole officer or case manager.
- The risk of complications and/or morbidity or mortality of patient management decisions made at the visit. The 2021 guidelines make it clear that options considered, but not selected, are still a factor for this element, specifically after “shared” MDM with the patient, family, or both. Examples include deciding against hospitalization for a psychiatric patient with sufficient support for outpatient care or choosing palliative care for a patient with advanced dementia and an acute condition.
AAPC. (2021, January 15). 2021 E/M coding changes. AAPC. https://www.aapc.com/evaluation-management/em-codes-changes-2021.aspx#:~:text=Office%20or%20other%20outpatient%20visit,decision%20making%20of%20low%20complexity.