Gastroenterology Coding Alert

Plus: What’s the proposed conversion factor for 2019?

Although the potential E/M changes that could come your way in January are getting the most ink in stories about the 2019 Fee Schedule proposal, the document does include some other updates that could impact your GI practice. Read on for a few highlights.

Get to Know How Pay Could Change in 2019

In addition to the Fee Schedule proposals that could impact E/M coding, CMS also made additional suggestions in the document that could impact GI practices nationwide. Across the board, the Medicare Physician Fee Schedule (MPFS) proposals keep the agency’s “Patients Over Paperwork” pledge on the federal healthcare delivery plate. Every aspect of the proposed rule promotes CMS’s heightened focus on utilizing health IT to enhance care and cut costs while decreasing clinicians’ workloads.

Here are a few of the highlights from the 1,000-page-plus CY 2019 MPFS proposed rule:

Conversion factor:  Lower than last year’s 10-cent bump, the conversion factor proposal is nothing to write home about at a 6-cent increase for inflation and slated to go from $35.99 to $36.05.

• QPP. The MPFS proposals include transition updates, cost and quality scoring changes, threshold guidance, small practice bonus downgrades, and several tech-friendly policies that bring Promoting Interoperability (PI) to center of MIPS.
• Telehealth. Two more codes for telehealth — HCPCS codes G0513 and G0514 (Prolonged preventive service[s]) — as well as 2018 Bipartisan Budget Act telehealth requirements for end-stage renal disease (ESRD).
• Virtual care. Payment increases for the use of audio and visual communication that “leverage technologies.” This includes a small payment for patients “checking in” with the provider via electronic means when the service isn’t attached to a visit.
• Medicare Advantage. MIPS requirements would be waived for Medicare Advantage providers interested in participating in the QPP. The program will be called the “Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) demonstration” and is for clinicians whose “arrangements are similar to Advanced APMs,” explains the fact sheet.

Potential New Gastro Tube Replacement Code

CMS is proposing the addition of two new codes that would describe gastrostomy tube replacement, as follows:

• 43X63 — Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance; not requiring revision of gastrostomy tract
• 43X64 — Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance; requiring revision of gastrostomy tract

Keep in mind that these codes are not final, but if they are implemented, the “X” character will be replaced by a numerical digit. Surgeons sought this change for the relatively few situations where gastrostomy tract revision must be performed to facilitate gastrostomy replacement.

Check the Final Calculations

Based on all of the proposed changes, CMS projects that independent laboratories lead the pack of specialists who will prosper in 2019 if the proposed fee schedule is finalized, with an estimated combined increase of four percent, while rheumatologists, hematologists/oncologists, and diagnostic testing facilities look to see the biggest declines at minus four percent. GI specialists aren’t facing either extreme, as the fee schedule indicates that under the proposal, gastroenterologists would see a payment increase of one percent.