Part B Insider (Multispecialty) Coding Alert

Physician Notes:

Get Ready for Overhauled EHR Incentive Program

Published on Mon Jan 25, 2016

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Plus: CCI takes aim at new prolonged service codes.

CMS projects that by the end of this year, 30 percent of Medicare payments will be linked to quality of care rather than the quantity of procedures performed—and that transition will impact every aspect of your payments, including your electronic health records (EHRs). To that end, the agency is overhauling the EHR incentive program that you’ve gotten to know since CMS debuted it in 2009.

“We have been working side by side with physician organizations and have listened to the needs and concerns of many about how we can make improvements that will allow technology to best support clinicians and their patients,” said CMS Administrator Andy Slavitt and Karen DeSalvo, MD, National Coordinator for Health IT in a Jan. 19 announcement.

CMS is currently working under four principles that will guide the EHR transition, as follows, Slavitt and DeSalvo noted:

Rewarding providers for outcomes that they can achieve with patients via technology
Giving practices the flexibility to customize their health IT systems to their needs
Offering more avenues to access electronic health information, such as apps and plug-ins
Creating national interoperability standards to ensure data flows appropriately.

CMS intends to work closely with the provider community as the agency further fine-tunes the upcoming EHR transition. To read more about the program, visit http://blog.cms.gov/2016/01/19/ehr-incentive-programs-where-we-go-next/.

In other news…

Just as quickly as several new CPT^® codes went into effect, the new edition of the Correct Coding Initiative (CCI) ensured that you can’t report them all together. CCI version 22.0, which went into effect on Jan. 1, impacts the following prolonged services codes:

99415 - Prolonged clinical staff service (the service beyond the typical service time) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; first hour (List separately in addition to code for outpatient Evaluation and Management service)
99416 - Prolonged clinical staff service (the service beyond the typical service time) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; each additional 30 minutes (List separately in addition to code for prolonged service).

You should consider these codes included in Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) and G0101 (Cervical or vaginal cancer screening; pelvic and clinical breast examination). All of these edits include a modifier indicator of “1.”

Note: You should also consider these prolonged services codes (99415, 99416) included in 99497.

Finally, your preventive codes (9938x-9939x) and E/M codes (99201-99225) now include ventilation codes (94002-94004, 94660-94662). All of these edits include a modifier indicator of “0,” meaning you cannot separate these edits under any circumstances.