2021 E/M Coding Revisions and Updates for Dermatology Practices

This transcript covers a presentation on the 2021 revisions and updates for evaluation and management (E/M) coding specifically tailored for dermatology practices. The speaker, who has a long history with the CPT editorial panel, addresses significant changes including the alignment of inpatient and outpatient codes and the implications for billing, particularly in terms of consult codes and modifier usage. Notably, Medicare has discontinued coverage for consults, whereas some commercial payers still do. The speaker elaborates on various coding edits, specifically CCI (Correct Coding Initiative) and MUE (Medically Unlikely Edits), emphasizing the importance of understanding limits, such as the cap on biopsies. The discussion also highlights that level 4 and 5 services can be attained through appropriate medical decision-making and complexity, often necessitating the submission of detailed documentation to justify additional billing under certain circumstances. The introduction of new biopsy codes and the intricacies of billing practices, including the appropriate application of modifier 59, is also discussed. Moreover, the speaker outlines the risk assessment parameters for E/M levels, detailing how unique patient risks and social determinants of health can influence billing level qualifications. The session concludes with a Q&A that addresses some specific coding concerns and the appropriate use of certain codes, such as G2211, related to managing complex patient scenarios.