CMS Confirms the Direction E/M Changes

As we approach 2020, we are gearing up for the changes that are making headway the coming year. Below are some of the updates that have been released regarding E/M changes, the final rule, and the physician fee schedule. For more information read below. For more on the services Welter Healthcare Partners provides contact us at 303.534.0388, or click here!nnWhat’s New for 2020 nnThe CY 2020 PFS conversion factor will increase to $36.0896, up to $0.05 from CY 2019. nnThree new Telehealth Service codes added to the Medicare-covered services list: n

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  • G2086 (Office‐based treatment for opioid use disorder, including the development of the treatment plan, care coordination, individual therapy, and group therapy and counseling; at least 70 minutes in the first calendar month)

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  •  G2087 (Office‐based treatment for opioid use disorder, including care coordination, individual therapy, and group therapy and counseling; at least 60 minutes in a subsequent calendar month).

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  • G2088 (Office‐based treatment for opioid use disorder, including care coordination, individual therapy, and group therapy and counseling; each additional 30 minutes beyond the first 120 minutes).

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nCMS will offer these services without the usual geographical limitations for telehealth. The Medicare telehealth originating site fee increased to $26.65 in 2020, from $26.15 in 2019.nnPrincipal Care Management (PCM) for Chronic Care Management (CCM) nnIf you provide chronic care management (CCM) to patients with one chronic condition next year, report code G2064 for 30 minutes of work by a doctor or other qualified health care professional: “Comprehensive care management services for a single high‐risk disease, e.g., principal care management, at least 30 minutes of physician or other qualified health care professional time per calendar month with the following elements: One complex chronic condition lasting at least three months, which is the focus of the care plan, the condition is of sufficient severity to place patient at risk of hospitalization or have been the cause of a recent hospitalization, the condition requires development or revision of disease‐specific care plan, the condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities.” When clinical staff performs the work, you will report G2065.nnReduction of Administrative Burden nnModifications to the documentation policy now allows physicians, physician assistants, and advanced practice registered nurses (APRNs – nurse practitioners, clinical nurse specialists, certified nurse‐midwives and certified registered nurse anesthetists) to review and verify (sign and date), rather than re‐documenting, notes made in the medical record by other physicians, residents, medical, physician assistant, and APRN students, nurses, or other members of the medical team. CMS also defined the APRN group of providers, which includes nurse practitioners, clinical nurse specialists, certified nurse‐midwives and certified registered nurse anesthetists.nnPhysician Assistants Make Ground n

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  • CMS’ finalized its proposal to adjust the authority of physician assistants (PA): Allowing them to practice without specific assignment to an M.D., requiring only “documentation in the medical record of the PA’s approach to working with physicians”. o Requires that in states where the PA’s scope of practice is not specified, the PA’s “working relationship” with the practice’s physicians must be documented “at the practice level.”

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  • CMS cautiously approved its proposal to allow certified registered nurse anesthetists (CRNAs) to do pre‐anesthesia assessments on patients, as well as post‐anesthesia assessments without the supervision of an M.D. CMS, clarifies that “a physician must examine the patient to evaluate the risk of the procedure to be performed,” while either “a physician or anesthetist must examine the patient to evaluate the risk of anesthesia.”

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nCMS Final Rule Aligns with E/M Coding Changes Laid Out by the CPT Editorial Panel for Office/Outpatient E/M Visits Beginning in 2021 n

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• Reduce the number of levels to 4 for office/outpatient E/M visits for new patients (99202‐99205);

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• Retain all 5 levels of coding for established patients (99211‐99215);

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• Revision of time‐based reporting and medical decision‐making process for all office‐based E/M codes; performance of history and exam only as medically appropriate (complexity will be more clearly defined);

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• E/M visit level selected based on either medical decision making or time.

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• CMS also finalized the relative value units (RVU) for the group of oft‐used E/M services, which will determine 2021 pay rates. The RVU changes, for example, would boost payments for code 99214 – the most‐reported E/M code – from $109 to $136 per claim, a 25% increase. Rates for 99213 would jump nearly 30%.

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nFor more information on these updates visit pbn.decisionhealth.com, ama-assn.org, cms.gov, and aafp.orgnn nn nn