Pulmonology Coding Alert

Plus: The updated fee schedule also includes changes to supervision rules.

If you were among the people anxiously awaiting details from the Medicare Physician Fee Schedule (MPFS) final rule, the time is here — but fortunately, pulmonology practices may not have anything to be anxious about this year.

Background: CMS released the 2021 MPFS final rule on Nov. 30, 2020, a month later than usual due to the public health emergency (PHE). To get a feel for how the provisions might impact your practice, check out a few essential points.

Last-Minute Reprieve Helps Practices

Although CMS initially imposed a 2021 MPFS conversion factor of $32.4085, a 10.2 percent decrease from the 2020 rate of $36.0896, that was reversed in the Consolidated Appropriations Act of 2021, which was signed into law on Dec. 27.

“In order to support physicians and other professionals in adjusting to changes in payment for physicians’ services during 2021, the Secretary shall increase fee schedules … for such services furnished on or after January 1, 2021, and before January 1, 2022, by 3.75 percent,” the bill reads.

Check Changes to Telehealth Services

• CMS added several additional codes to the telehealth list on a category 3 basis, including the following:
• Domiciliary, rest home, or custodial care services, established patients (99336-99337)
• Home visits, established patient (99349-99350)
• Emergency department visits (99281-99285)
• Nursing facilities discharge day management (99315-99316)
• Psychological and neuropsychological testing (96130- +96133; 96136-+96139)
• Therapy services, physical and occupational therapy (97161-97168; 97110,97112, 97116, 97535, 97750, 97755, 97760, 97761, 92521-92524, 92507)
• Hospital discharge day management (99238-99239)
• Critical care services (99291-+99292)
• Subsequent observation and observation discharge day management (99217; 99224-99226)

Here’s what that means: “Category 3 describes services added to the Medicare telehealth list during the public health emergency (PHE) for the COVID-19 pandemic that will remain on the list through the calendar year in which the PHE ends,” according to a CMS release.

In addition, many services under the MPFS can be delivered by auxiliary personnel under the direct supervision of a physician. In these cases, the supervision requirements necessitate the presence of the physician in a particular location, usually in the same location as the beneficiary when the service is provided. During the PHE, CMS is temporarily modifying the direct supervision requirement to allow for the virtual presence of the supervising physician using interactive audio/video real-time communications technology.

Nonphysician Practitioners See New Supervision Rules

Under the new MPFS, CMS will allow nurse practitioners, clinical nurse specialists, physician assistants, and certified nurse-midwives to supervise the performance of diagnostic tests. CMS granted this flexibility during the COVID-19 PHE and is now going to extend it permanently. The agency expressed concern about ensuring an adequate workforce is areas where there are shortages and seeks information about states that have scope of practice laws in place.

Check These Medical Documentation Requirements

In last year’s rule, CMS finalized numerous changes to the medical record documentation requirements for physicians and other healthcare practitioners. In the new 2021 final rule, CMS is clarifying that physicians and other healthcare practitioners, including therapists, can review and verify documentation entered into the medical record by members of the medical team for their own services that are paid under the MPFS. Although CMS finalized this change, be sure to consider State Scope of Practice Guidelines, facility bylaws and all other applicable regulations.

Look for MIPS Updates

The MPFS includes several updates to the Merit-based Incentive Payment System (MIPS) that will be of strong relevance to physicians:

• 2020 Reporting Exemptions Due to COVID-19: CMS is granting hardship exemptions on a case-by-case basis due to COVID-19. It is therefore possible for a clinician or group to request exemption from all four performance categories in 2020. If clinicians submit a hardship exception application for all four MIPS performance categories, and their application is approved, they will be held harmless from a payment adjustment in 2022 — meaning that they will not be eligible for a bonus and not face a penalty based on their MIPS performance in 2020. The final rule also published a continuation of the hardship exception process for 2021.

• Performance Threshold: CMS has set the threshold that clinicians need to achieve to avoid a penalty in 2021 at 60 points. In the proposed rule, CMS had stated that the performance threshold would be 50 points in 2021, but CMS is now instituting a higher threshold.
• MIPS Value Pathways (MVPs): CMS is committed to developing MVPs, which would combine all four categories of MIPS reporting into a single, more harmonized process. However, due to COVID-19, the implementation of MVPs is being delayed until 2022.

Resource: To read the MPFS in its entirety, visit https://public-inspection.federalregister.gov/2020-26815.pdf.