General Surgery Coding Alert

The Medicare Physician Fee Schedule (MPFS) final rule contains no surprises regarding when the big changes to E/M services will take place — that will still be Jan. 1, 2021.

Even with the implementation pause, here are two takeaways from the final rule that you need to know:

Reversal: The 2020 final rule puts an end to CMS’s controversial proposal to blend E/M level payments. As it stood, the proposal to merge E/M levels 2-4 for both new and established patients and reimburse them at the same rate “would have caused a real issue with medical care — as why would a physician spend the time it takes to perform a 99214 [Office or other outpatient visit …] when they would get reimbursed the same as a 99212,” notes Donelle Holle, RN, a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana. “The other fear was that, due to the payment reform, providers would try to get to that 99215 without showing medical necessity.”

Enactment: CMS is still going ahead with its decisions to delete E/M code 99201, to adopt the CPT^® interpretive guidelines for medical decision making (MDM). and to let you use either MDM or time to select the level of the outpatient E/M service. This will “bring Medicare in line with what will be in CPT^® in 2021, which should simplify matters for practices as compared to having Medicare-specific rules,” says Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians.