Heads Up for Healthcare –
NEW E/M Coding Changes Coming 2019
We all know that change is the only constant in the Medical Coding world. This recent CMS release of coding initiatives in 2019 proposes a pretty significant change for Evaluation and Management (E/M) coding that can impact doctor visits for both the patients and the providers in a good way.
According to CMS Secretary, Verma Seema, “Patients are demanding more accountability from healthcare providers and payers, and they want to see what they’re getting for the high insurance and co-pay amounts paid.”
What patients see, is the attention and time spent with their physician. Physicians complain that the time spent inputting information cuts into face-to-face time with the patient. The pressure to increase patient loads requires providers to keep visits short but effective. Time is the common denominator that will be addressed through these coding changes.
What does that mean for you? Less is more.
The #PatientsOverPaperwork Initiative focuses on value-based healthcare by simplifying the complexity of required documentation during an office visit. This change will enable physicians to return to focusing on attentive, quality care by spending more time with the patient rather than spending their time documenting visit to meet the paperwork requirements involved.
E/M Visit Payment Changes & Reimbursement Rates
- E/M Coding levels 2-5 will be consolidated to a single reimbursement code and must meet the following requirements
- EPF History (a chief complaint with 1-3 HPI elements)
- 1 review of symptoms
- And EPF Exam
- And a Straightforward MDM
- Add on codes may also be applied for additional reimbursement and payment adjustments.
+ $5 for additional resources in complex E/M visits associated with primary care service
+ $9 for additional resources in complex E/M visits involving non-procedural based care
– Multiple procedure payment reductions when E/M visit and a procedure are furnished on the same day
+ Add-on for a 30-minute prolonged E/M visit.
- E/M Level 1 rates will be adjusted
- $24 for established patients
- $44 for new patients
The proposed changes depicted above are in a 60-day comment period. CMS welcomes and encourages provider feedback as a critical part of the coding change process. This is to ensure that all coding changes benefit not only the patient, but the providers that treat them as well.
“As part of @POTUS‘s Cut the Red Tape Initiative, CMS launched our Patients Over Paperwork Initiative to reduce unnecessary and redundant regulations so that doctors could focus on their primary mission – taking care of their patients.” #PatientsOverPaperwork
— Administrator Seema Verma (@SeemaCMS) July 25, 2018
If you have questions or would like to provide feedback about how these coding changes may effect your E&M visits and reimbursement, you can join the conversation via Twitter using hashtag, #PatientsOverPaperwork and tweet to @SeemaCMS and @MEREMHealth.