CDT and CPT - The Same but Different!

December 8th, 2020 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
Categories:   CPT® Coding   Dental   Evaluation & Management (E/M)  

Reporting a CPT code for an evaluation of a patient is based on time and if the patient is a new or established patient. Evaluation and Management codes are different than other codes, so it is important to understand how they are used. Prior to 2021 they were based on a point system where the codes were required to meet a specific level of history and exam. The need to score history and exam are being eliminated and beginning January 01, 2021, E&M codes will be based on a medical necessity based system or in other words; medical decision making (MDM) or time. Seeing patients in an office or clinic setting and reporting 99202-99215 are impacted by these changes. The first impact is the deletion of 99201, making 99202 the lowest based office visit. 

2021 E&M codes are based on the following:

CPT® Code Set

Evaluation and Management Services

99091 99474     Non-Face-to-Face Services
99202 99215     Office or Other Outpatient Services

With services being reported on time, we will now document the number and complexity of problems addressed at the encounter. Although medically appropriate history and exam will not determine code selection, the entire visit still needs to be documented. For example, if the history and exam findings are pertinent to the visit, it must be documented.   

According to the March 2020 CPT assist "E/M Office or Other Outpatient Visit Revisions for 2021:

Time:" beginning, Jan 01, 2021, the following activities are considered on the day of the encounter whether face-to-face or Non-Face-to-face for office or other outpatient visits when calculating time spent by the physician or other QHP"

  • preparing to see the patient (eg, review of tests)

  • obtaining and/or reviewing separately obtained history

  • performing a medically appropriate examination and/or evaluation

  • counseling and educating the patient/family/caregiver

  • ordering medications, tests, or procedures

  • referring and communicating with other health care professionals (when not separately reported)

  • documenting clinical information in the electronic or other health records

  • independently interpreting results (when not separately reported) and communicating results to the patient/family/caregiver

  • care coordination (when not separately reported)

Dental codes are reported under the Diagnostic code set D0120-D0999. Find-A-Code offers crosswalks from CPT to CDT and back again, found under Cross-A-Code on the code information page. 

CDT® Dental Codes ("D" Codes)

I. Diagnostic   

D0120 D0180     Clinical Oral Evaluations
D0371 D0395     Diagnostic Imaging
D0411 D0603     Tests and Examinations
D0472 D0502     Oral Pathology Laboratory (Use Codes D0472-D0502)
D0190 D0191     Pre-Diagnostic Services
D0999   Unspecified diagnostic procedure, by report

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

Reporting Modifiers 76 and 77 with Confidence
April 18th, 2023 - Aimee Wilcox
Modifiers are used to indicate that a procedure has been altered by a specific circumstance, so you can imagine how often modifiers are reported when billing medical services. There are modifiers that should only be applied to Evaluation and Management (E/M) service codes and modifiers used only with procedure codes. Modifiers 76 and 77 are used to identify times when either the same provider or a different provider repeated the same service on the same day and misapplication of these modifiers can result in claim denials.
Five Documentation Habits Providers Can Use Implement to Improve Evaluation & Management (E/M) Scoring
April 11th, 2023 - Aimee Wilcox
Provider education on E/M coding updates is vital to the success of any organization, but how do you whittle down the massive information into bite-sized pieces the providers can learn in just a few minutes? Check out the five steps we have identified to teach providers in just a few minutes that can significantly impact and improve coding outcomes.
Second Quarter 2023 Updates are Different This Year
April 6th, 2023 - Wyn Staheli
The second quarter of 2023 is NOT business as usual so it is important to pay attention to ensure that organizational processes and training take place to avoid mistakes. Not only have ICD-10-CM coding updates been added to the usual code set updates (e.g., CPT, HCPCS, ICD-10-PCS), but the end of the COVID-19 Public Health Emergency will bring about changes that will also take place during the quarter (but not on April 1, 2023.
7 Measures Developed by the HHS Office of Inspector General (OIG) to Identify Potential Telehealth Fraud
March 28th, 2023 - Aimee Wilcox
A recent review of telehealth services reported in Medicare claims data during the pandemic where these seven measures for identifying suspected fraud, waste, and abuse were applied, revealed more than a thousand Medicare providers potentially committed fraud during this period. What are the measures the OIG applied during their review, and how will that impact future telehealth guidelines moving forward?
MUEs and Bilateral Indicators
March 23rd, 2023 - Chris Woolstenhulme
MUEs are used by Medicare to help reduce improper payments for Part B claims. This article will address the use of the National Correct Coding Initiative (NCCI) and Medically Unlikely Edits (MUEs) and how they are used by CMS.
It is True the COVID-19 PHE is Expiring
March 16th, 2023 - Raquel Shumway
The COVID-19 PHE is Expiring, according to HHS. What is changing and what is staying the same? Make sure you understand how it will affect your practice and your patients.
Billing Process Flowchart
March 2nd, 2023 -
The Billing Process Flowchart (see Figure 1.1) helps outline the decision process for maintaining an effective billing process. This is only a suggested work plan and is used for demonstration purposes to illustrate areas which may need more attention in your practice’s policies and...



Home About Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2023 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association