The 2019 Medicare Physician Fee Schedule (MPFS) proposed rule discussed potential add-on codes to represent Evaluation and Management complexity. Lucky for physician specialties, it been delayed until 2021. The proposed add-on code was a way to add reimbursement in the new territory of blended E&M payments.

For physician specialties, CMS is proposing to revise the current five levels of reporting patient office visits into two levels, one for new patients and one for established patients.  This proposal would also change the documentation required to support the billing of E&M codes. 

This proposal would eliminate separate billing of E&M codes when those visits are furnished in conjunction with other procedures, by applying a multiple procedure payment adjustment in those circumstances.

The proposed add-on code for specialists is temporarily called GCG0X. The code would represent additional costs for resources in specialties that have E&M visits as a big percentage of the allowed charges. These specialties typically report level 4 and 5 visits. They often use E&M codes rather than separate codes for the treatments provided to the patient.

The specialties for the add-on codes include Endocrinology, Rheumatology, Hematology/Oncology, Urology, Neurology, OB/GYN, Allergy/Immunology, Otolaryngology, or Interventional Pain Management-Centered Care. The add-on code would be listed separately in addition to the E&M visit code.

The proposed value of the code was based on 75% of psychiatric evaluation/psychotherapy code +90785.  Medicare has made the decision for the primary RVU to be the same as the specialty, which means the new proposed RVU is 0.25 with a physician time of 8.25 minutes.

Accuracy in medical coding is the life-blood of all medical practice. It takes a knowledgeable and experienced coding staff to maximize your billed charges while maintaining strict compliance with CMS and CCI guidelines. That is why these add-on codes will be something we watch for in 2021 within these specialties. Trust the coding experts at MEREM Healthcare Solutions.