AMA CPT® Assistant - 2021 Issue 10 (October)
Frequently Asked Questions
October 2021 page 13 Frequently Asked Questions Evaluation and Management (E/M): Office or Other Outpatient Services Question: If a laboratory test is ordered and a review of the results of that laboratory test must be combined with other criteria to count as one data element under the 2021 E/M guidelines for medical decision making (MDM), why are there separate bulleted items for review of the results and ordering of each unique test for Category 1 as part of Table 2, Levels of Medical Decision Making in the Current Procedural Terminology (CPT ®) code set? Answer: Table 2, Levels...
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Article Overview
This FAQ article reviews a range of coding questions drawn from multiple CPT sections, including evaluation and management, surgery, pathology and laboratory, and physical medicine and rehabilitation. It is aimed at coders, billers, and compliance professionals who need a high-level understanding of the subjects discussed in the 2021 CPT code set and related guidance from professional coding sources. The article addresses broad topics such as medical decision making, procedure reporting, unlisted services, modifiers, and laboratory test reporting.
Why This Topic Matters
It helps readers determine whether the article contains guidance relevant to common coding questions across several specialties and service categories, while also showing which CPT-related topics and code areas are covered.
Article Sections
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Evaluation and Management (E/M): Office or Other Outpatient Services
Questions in this section focus on CPT evaluation and management guidance for office or other outpatient settings. The discussion centers on medical decision making concepts and related 2021 coding framework issues.
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Surgery: Integumentary System
This section addresses a surgical coding scenario involving the integumentary system. It provides a question-and-answer discussion tied to procedure reporting considerations in CPT.
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Surgery: Musculoskeletal System
This section covers a musculoskeletal surgery coding question involving procedure relationships and a modifier referenced in CPT and related bundling guidance.
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Surgery: Hemic and Lymphatic Systems
This section discusses a lymphatic-system surgery question involving an unlisted-procedure reporting scenario after breast surgery. It reflects coding guidance for a specialized reconstructive service area.
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Surgery: Digestive System
This section presents a digestive-system procedure reporting question involving a gastrostomy-related service. The discussion is framed around CPT surgical coding and procedural documentation.
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Surgery: Female Genital System
This section addresses a gynecologic coding question involving cervical dilation and uterine access. It compares related CPT procedure reporting concepts within the female genital system.
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Pathology and Laboratory: Chemistry
This section covers laboratory chemistry coding questions, including stimulation testing and a specialized biomarker reporting issue. It also references changes in CPT coding support materials over time.
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Medicine: Physical Medicine and Rehabilitation
This section asks about a medicine service category in physical medicine and rehabilitation. The topic concerns negative-pressure wound therapy and the scope of applicable wound types.
What You Will Learn
- How CPT FAQ guidance addresses selected evaluation and management topics
- How surgical procedure reporting questions are handled across multiple body systems
- How unlisted procedure reporting and modifier use may come up in CPT discussions
- How laboratory test reporting issues are discussed when panel coding is not available
- How medicine-category guidance may clarify the scope of a therapy service
Who Should Read This
- Medical coders
- Coding auditors
- Billing specialists
- Compliance staff
- Physician practices
- Hospital coding departments
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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