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Pulmonology Coding Alert

News Brief:

Draft E/M Guidelines Scrapped

Published on Sat Sep 01, 2001

Testifying before the House Ways and Means Committee on July 19, 2001, Tommy Thompson, secretary of the Department of Health and Human Services (HHS), announced a change in the development of the new E/M guidelines used to bill Medicare and other insurers.
 
The HHS has been working with an independent contractor, Aspen Systems, to develop an alternative to the current (1995 and 1997) guidelines, which Thompson characterized as cumbersome. Although the proposed guidelines were intended to reduce burdens on physicians, according to Thompson, physicians have continued to express concern that these guidelines are hindering, not helping, the delivery of appropriate patient care. Therefore, he elaborated, I have directed Aspen Systems to stop their work on this current draft while we reassess and retune our effort.
 
Thompson said that he welcomed input from the physician community to design constructive solutions. After six years of confusion, I think it makes sense to try to step back and assess what we are trying to achieve, he said. We need to go back and re-examine the actual codes for billing doctor visits. For the system to work, the codes for billing these visits need to be simple and unambiguous. I look forward to working with the AMA and other physician groups to simplify the codes and make them as understandable as possible.
 
Thompsons remarks suggest that new E/M codes, along with new guidelines for billing them, will be developed and incorporated into CPT. No time line for the revisions has been announced, suggesting that the 1995 and 1997 guidelines will remain the standard for several years.

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