CMS issues clarification of E&M policy  

Category: Coding

Since January 1, 2010-when CMS decided to no longer recognize the CPT consult codes for payment (99241-99255)-some E/M coding issues arose that made things a bit more fuzzy.

One issue, for example, is the fact that prior to the change, it used to be understood that the initial hospital care codes (99221-99223) were to be used by the admitting physician. To this day, CPT still states that the initial hospital care codes are used to report the first hospital inpatient encounter with the patient by the admitting physician. CMS no longer follows this CPT coding rule since it states that the initial hospital care codes can be used to describe the initial inpatient service by a physician as long as the complexity of the service meets the minimum requirements as defined by the key components of the code even if they are not the admitting physician.

The -AI modifier indicates th...