2022 billing and coding updates
Teaching physician services
As a general rule, a teaching physician can bill for the resident services only if they are present for the critical (key) portion of the service. But, there is one exception called the “primary care exception” under which in certain teaching hospital primary care centers, the teaching physician can bill for certain services as furnished independently by the resident without the teaching physician being physically present, but with the teaching physician’s review.
The current model to bill for office/outpatient E/M visit level is either based on either total time spent (personally) or medical-decision-making (MDM). When time is used to select the visit level only the time spent by the teaching physician in qualifying activities can be included for the purposes of the visit level selection. And, this includes the time the teaching physician was present with the resident performing those qualifying activities. Also, under the primary care exception, time cannot be used to select the visit level. This is to guard against the possibility of inappropriate coding that reflects residents’ inefficiencies rather than a measure of the total medically necessary time required to furnish the E/M services.
ICD-10 updates
Usually, the ICD-10 codes are updated annually and take effect every October 1. Some of the most relevant updates are as follows:
1. U09.9 Post COVID-19 condition, unspecified: This should be used to document sequelae of COVID-19 or “long COVID” conditions, after the acute illness has resolved. But, remember to code the conditions related to COVID-19 first and do not use this code with an active or current COVID-19 infection.
2. U07.0 Vaping-related disorder: This should be used for all vaping-related illnesses. However, additional codes for other diagnoses such as acute respiratory failure, acute respiratory distress syndrome, or pneumonitis can also be used with this code. Other respiratory signs and symptoms such as cough and shortness of breath should not be coded separately.
3. Cough is one of the most common reasons for referral to a pulmonologist. The CDC has expanded these codes so please remember to code the most specific diagnosis as deemed appropriate.
R05.1 Acute cough
R05.2 Subacute cough
R05.3 Chronic cough
R05.4 Cough, syncope
R05.8 Other specified cough
R05.9 Cough, unspecified
We will be back with some more exciting and intriguing billing and coding updates in our next article and hope to see everyone at CHEST 2022 in Nashville., TN.
