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No Changes to E/M Payment Until at Least 2021

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  • November 1, 2018
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No Changes to E/M Payment Until at Least 2021

The 2019 Physician Fee Schedule and Quality Payment Program final rule has come out.
The Centers for Medicare & Medicaid Services (CMS) announced Nov. 1 they are not going to make changes to payment for evaluation and management (E/M)  services until at least 2021. CMS Administrator Seema Verma said in a press release, “We know that this is going to have a tremendous impact on many doctors in America, and we want to make sure we get this right.”

Reducing E/M Burden

When the PFS proposed rule was released, the American Medical Association (AMA) praised CMS’ efforts to reduce the burden imposed by the current E/M documentation rules, but voiced concerned that the proposed payment structure of a single payment level for new patients (99202-99205) and a single payment level for established patients (99212-99215) and basing the E/M level on the current calculation of medical decision-making (MDM) left “a number of unanswered questions and potential unintended consequences.” The AMA asked that the change be delayed for one year, until 2020, and that a work group be convened to better address how the changes to reduce the burden on providers for E/M documentation be developed over the next year, in time for the 2020 fee schedule.
AAPC also submitted feedback to CMS during the PFS proposed rule comment period.
CMS finalized some of their proposed changes and delayed changes to reduce the burden on documentation, coding, and payment until calendar year 2021, according to a CMS fact sheet. The current documentation, coding, and payment for E/M visits will continue to be based on the 1995 or 1997 documentation guidelines for the next two years.
The proposed payment changes for collapsing the multiple levels for outpatient new and established patients is also being delayed until 2021. CMS is changing how they are viewing the single rates based on the feedback that CMS received regarding the proposed rule. Instead of collapsing levels 2-5 (99202-99205 and 99212-99215) into one as proposed payment for new patients and one for established patients, CMS is collapsing the first four levels (99201-99204 and 99211-99214) into one payment for each of new patient and established patient and has kept a separate higher payment for the fifth level, 99205 and 99215.

No Reduction for E/M

CMS has also decided not to reduce payment for E/M services provided on the same day as minor procedures. Nor will they create separate coding and payment for podiatric E/M visits. Standardized allocation of practice expense relative value units for certain codes has also been scrubbed for now.
Also in the PFS final rule, CMS is finalizing:

  • Elimination of the requirement to document the medical necessity of a home visit in lieu of an office visit.
  • For established patient office/outpatient visits, when relevant information is already contained in the medical record, practitioners may choose to focus their documentation on what has changed since the last visit, or on pertinent items that have not changed, and need not re-record the defined list of required elements if there is evidence that the practitioner reviewed the previous information and updated it as needed. Practitioners should still review prior data, update as necessary, and indicate in the medical record that they have done so.
  • CMS clarified that for E/M office/outpatient visits, for new and established patients for visits, practitioners need not re-enter in the medical record information on the patient’s chief complaint and history that has already been entered by ancillary staff or the beneficiary. The practitioner may simply indicate in the medical record that they reviewed and verified this information.
  • Removal of potentially duplicate requirements for notations in medical records that may have previously been included in the medical records by residents or other members of the medical team for E/M visits furnished by teaching physicians.

CMS is adding two new G codes for services furnished using communication technology:

  • Brief communication technology-based service, e.g. virtual check-in (HCPCS Level II G2012)
  • Remote evaluation of recorded video and/or images submitted by an established patient (HCPCS Level II G2010)

Providers may be separately paid for a brief communication technology-based service when the patient checks in with the provider via telephone or other telecommunications device to decide if an office visit or other service is needed. This is designed to increase efficiency for providers as well as provide convenience for beneficiaries.
The conversion factor for 2019 physician fee schedule is $36.04, which is a small increase over the 2018 conversion factor of $35.99.

Evaluation and Management – CEMC

Barbara Cobuzzi

About Has 99 Posts

Barbara J. Cobuzzi, MBA, CPC, COC, CENTC, CPC-P, CPC-I, CPCO, CMCS, is CEO of CRN Healthcare Solutions and formerly owned a medical billing company. Cobuzzi is a subject matter expert in otolaryngology coding. She provides litigation support as an expert witness for providers and payers and often presents for many local and national organizations. She is also a consulting editor for AAPC’s Otolaryngology Coding Alert newsletter. In 1999, Cobuzzi was named AAPC’s Networker of the Year, and she is a past member of the National Advisory Board. She is one of four founding members of the Monmouth/Ocean, N.J., local chapter and is still active with the chapter.

No Responses to “No Changes to E/M Payment Until at Least 2021”

  1. holly cassano says:

    Great Article Barbara!

  2. Olivia says:

    Really informative article.