Appendix C of Current Procedural Terminology (CPT®) includes clinical examples for evaluation and management (E/M) service codes by specialty. While these examples have been helpful in presenting the types of problems that might require different levels of E/M services, there have been reports of misuse of these examples in lieu of the E/M coding guidelines to validate or discredit a level of service reported by physicians. This has been particularly concerning when the clinical examples were reportedly used to limit reporting of services by specialty and to deny or recoup payment for E/M services without regard to key components or time spent providing medically necessary services.
In response, CPT 2014 includes some important clarifications for the intent and use of these examples.
In support of these clarifications, the following changes are made to the prefatory text for Appendix C:
As indicated by these changes, physicians and coders may...