Neurology & Pain Management Coding Alert

No increase in pay for providers this year.

As if 2021 wasn’t enough of a gut punch, the final rule contained one last blow to close out the year — and it started 2022 with more of a whimper than a bang.

First things first: The conversion rate, which is the headliner in every final rule, was reduced slightly. There are also several other tidbits that will be of interest to coders as they tackle their claims in 2022.

Here’s what you need to know about the Centers for Medicare & Medicaid Services (CMS) final rule, which went into effect on Jan. 1, 2022.

CF Dips Slightly

Initially, CMS proposed a 2022 conversion factor (CF) of $33.5848; but after public comments, they finalized a CF of $33.5983. But the story of the 2022 MPFS CF still wasn’t completely written.

Public response: The significant CF reduction as the COVID-19 public health emergency (PHE) continued didn’t go unnoticed by healthcare organizations. The American Medical Association (AMA) is urged Congress to act to prevent further financial casualties.

“The AMA is strongly advocating for Congress to avert this and other looming cuts to Medicare physician payments that, overall, will produce a combined 9.75 percent cut for 2022. This comes at a time when physician practices are still recovering the personal and financial impacts of the COVID public health emergency,” says AMA President, Gerald E. Harmon, MD, in a statement. “Congress is beginning to recognize that this financial instability could limit health care access for Medicare patients”

Revised 2022 rate: Then on Dec. 16, 2021, CMS announced an updated CY 2022 CF of $34.6062. While this represents a 0.82% cut from the CY 2021 CF of $34.8931, it reflects an increase from the initial CY 2022 physician CF of $33.5983 announced in the CY 2022 MPFS final rule.

CMS Clears Up Split/Shared Rules

“CMS is proposing to continue its current policy allowing billing of certain ‘split’ or ‘shared’ E/M visits by a physician, when the visit is performed in part by both a physician and a nonphysician practitioner [NPP], who are in the same group and the physician performs a substantive portion of the visit,” explains Michael A. Granovsky, MD, CPC, FACEP, president of LogixHealth, a national coding and billing company. “CMS is limiting split or shared to E/M [evaluation and management] codes only, not procedures.”

Plus, CMS offers other insight on split/shared services in the rule, including how time factors into the E/M visits, reporting for new and established patients, modifiers, documentation, and codification of the revised policies.

Important: In a new definition, CMS explains that whoever provides the “substantive portion of the visit” bills for the services — whether it’s the physician or the NPP. “For 2022, the substantive portion can be history, physical exam, medical decision-making, or more than half of the total time (except for critical care, which can only be more than half of the total time),” CMS says in the fact sheet. But, “by 2023, the substantive portion of the visit will be defined as more than half of the total time spent.”

Table 26 from the final rule details the possibilities of determining the substantive portion of different visit types, Granovsky says.

Evolution Goes on for Medicare Telehealth

CMS is continuing to monitor the “Category 3” codes that it temporarily added to its Medicare telehealth services list during the COVID-19 PHE. But, the rule does finalize keeping “certain services” on the list through Dec. 31, 2023, to give CMS more time to evaluate the services, the fact sheet indicates.

“Category 3 telehealth services in the final rule include home visits for established patients, emergency department visits, critical care services, and hospital and nursing facility discharge day management services,” says partner attorney Eric D. Fader with law firm Rivkin Radler LLP in online legal analysis. “CMS also extended the inclusion of two new cardiac rehab codes through calendar year 2023.”

Behavioral health: CMS also added audio-only communications to its definition of interactive telecommunications system for telehealth services for the diagnosis, evaluation, or treatment of mental health disorders offered to established patients in their homes, the rule indicates. A new modifier for these services was also finalized in the rule.

CMS Makes CAA Mandate for PA Services Official

Section 403 of the Consolidated Appropriations Act, 2021 (CAA) mandated the removal of the federal requirement to only pay physician assistants’ (PAs’) employers or independent contractors for services provided by the PAs by Jan. 1, 2022. Now, PAs may bill Medicare directly for their professional services, reassign payment for their professional services, and incorporate with other PAs and bill Medicare for PA services,” the fact sheet says.