General Surgery Coding Alert

Look out for critical care bundles with global surgery.

With no end in sight for the COVID-19 public health emergency (PHE), the feds recently proposed expanding telehealth services into 2022.

The Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2022 Medicare Physician Fee Schedule (MPFS) proposed rule, published in the Federal Register on July 23. The proposal includes guidance on previous E/M changes, clarity on split/shared visits, new telehealth updates, and more. Plus, the agency proposes several pro-quality updates, pushing full-steam ahead with its Merit-Based Incentive Payment System (MIPS) Value Pathways program and recommending a major overhaul of the Medicare Shared Savings Program (MSSP) for accountable care organizations (ACOs).

Read on for a breakdown of changes you should anticipate for your general surgery practice.

Expect Lower Conversion Factor

CMS reevaluates the conversion factor (CF) in its fee schedule proposals — and the CY 2022 MPFS is no exception, offering a substantial CF cut as part of its budget adjustment.

Here’s why: The law requires CMS is to offer a “proposed budget neutrality adjustment to account for changes in [relative value units] RVUs” to align with inflation,” the agency reminds in a fact sheet on the rule.

2021: CMS opted to finalize a massive 10+ percent CF decrease in the CY 2021 MPFS amidst major blowback from industry organizations and stakeholders. But as COVID-19 numbers spiked in December 2020, Congress passed the Consolidated Appropriations Act, 2021 — a $900 billion COVID-relief bill — which included a one-time only 3.75 increase to the CF to accommodate cash-strapped providers.

Now: CMS proposes to make the CF $33.58, a $1.31 decrease from the current CF of $34.89, the proposed rule indicates. “The [M]PFS conversion factor reflects the statutory update of 0.00 percent and the adjustment necessary to account for changes in relative value units and expenditures that would result from our proposed policies,” CMS insists.

Check Out Telehealth Update

According to the proposed rule, CMS is still figuring out whether to make permanent certain codes that it temporarily added to the Medicare telehealth services list during the pandemic.

“CMS is proposing to allow certain services added to the Medicare telehealth list to remain on the list to the end of December 31, 2023, so that there is a glide path to evaluate whether the services should be permanently added to the telehealth list following the COVID-19 PHE,” the fact sheet says. This will give stakeholders extra time to weigh in on the additions, especially as the pandemic rages on.

Mental health, too: CMS wants to harness recent legislation to allow patients access to “telehealth services for diagnosis, evaluation, and treatment of mental health disorders” anywhere, including in the privacy of their own homes, a CMS fact sheet indicates.

The proposed changes would enable “mental and behavioral health providers to furnish audio-only telehealth services to established patients in their homes if such patients either have technical limitations or choose not to use interactive video,” point out attorneys Gregory Tanner and Jennifer Whitton with Baker & Hostetler LLP in Atlanta in online legal analysis.

Plus: The pandemic highlighted access issues for rural and underserved populations, so CMS also intends to pay for mental health visits at Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs), according to the proposed rule.

CMS also plans to add “a new category of digital health services — Remote Therapeutic Monitoring (RTM) — to complement the existing suite of Remote Physiological Monitoring (RPM) codes covered under Medicare,” note Tampa, Florida-based attorneys Nathaniel M. Lacktman and Thomas B. Ferrante with Foley & Lardner LLP in online legal analysis.

“These codes may very well bridge existing policy gaps in RPM services by enabling CMS to cover monitoring of data collected in various means not available under RPM,” explains Washington, D.C.-based attorney Jacob Harper with Morgan, Lewis & Bockius LLP in online legal analysis.

Notice Critical Care and Global Surgery Plans

While CMS continues to collect data to value surgical services, the agency plans to “bundle critical care visits with procedure codes that have a global surgical period,” according to the proposed rule

Reasoning: Because some procedures that currently have 10- and 90-day global packages include critical care visits, CMS wants to include those services in all global packages.

The proposed rule states, “We note that this proposal contrasts with the current policy as described in the Medicare Claims Processing Manual, which states that critical care visits are unbundled from procedures with a global surgical period as long as the critical care service was unrelated to the procedure.”

Spotlight Patient Access and Equity Proposals

The COVID-19 PHE was a factor in the substantial policymaking, but CMS maintains that many of the suggested changes address longstanding issues in healthcare and health equity that the pandemic revealed.

“Over the past year, the public health emergency has highlighted the disparities in the U.S. health care system, while at the same time demonstrating the positive impact of innovative policies to reduce these disparities,” explains CMS Administrator Chiquita Brooks-LaSure in a release on the proposed rule. “CMS aims to take the lessons learned during this time and move forward toward a system where no patient is left out and everyone has access to comprehensive quality health services.”

CMS is accepting comments on the proposed rule through Sept. 13.

Resource: Find the CY 2022 MPFS proposals in the Federal Register at www.federalregister.gov/documents/2021/07/23/2021-14973/medicare-program-cy-2022-payment-policies-under-the-physician-fee-schedule-and-other-changes-to-part.