Urology Coding Alert

E/M and quality measures still rank high in importance.

As you get more settled into 2018 from a coding and billing perspective, here are three important updates from the Center for Medicare and Medicaid Services (CMS) that your practice needs to be on par with.

E/M rules:  The jury is still out on proposed evaluation and management (E/M) documentation changes that impact the level of code providers use - which also happens to impact the amount providers are paid - as CMS continues to weigh stakeholders' comments. Despite admitting that the current requirements are "potentially outdated and need to be revised," the agency did not move forward with revisions like it originally proposed in July.

QPP updates:  Due to providers' confusion over the changes required by replacement of the Physician Quality Reporting System (PQRS) by the Quality category under the Merit-Based Incentive Payment System (MIPS), CMS decreased the requirements for 2016 reporting in the final rule. This adjustment changes the "reporting of 9 measures across 3 National Quality Strategy domains to ... reporting of 6 measures for the PQRS with no domain requirement," CMS noted. The final rule brings PQRS in alignment with Quality under MIPS and will reduce the chances of eligible clinicians getting a 2.0 percent pay cut in 2018.

MACRA-backed initiatives were updated in the MPFS final rule and include:

• Level II HCPCS modifiers for patient relationship categories are available for QPP claims starting Jan. 1, 2018. The use of the codes is not required, according to the final rule.
• Accountable Care Organizations (ACOs) partic­ipating in the Medicare Shared Savings Program will see a boost in 2018 with "three new chronic care management codes (CCM) and four behavioral health integration (BHI) codes" that support primary care. The MPFS also reduces administrative burdens and streamlines the options.
• CMS will reduce the 2018 Value Modifier negative payment rate to -2 percent for practices with 10 or more clinicians and -1 percent for solo physician and NPP practices or group practices with two to nine providers to promote the transition to incentive-based care under MIPS.

AUC delay: Sticking with its scaled-back efforts and MACRA alignment, CMS did not give a start date for the Medicare Appropriate Use Criteria (AUC) Program for Advanced Diagnostic Imaging. With a suggested start date of Jan. 1, 2020, "qualified provider-led entities are permitted to develop AUC, and qualified clinical decision support mechanisms are the tools that physicians use to access the AUC," notes the agency guidance. "Physicians may begin exploring these mechanisms well in advance of the start of the Medicare AUC program through the voluntary participation period that will begin mid-2018 and run through 2019."

Resource: For a look at the Medicare Physician Fee Schedule Final Rule fact sheet, visit www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-11-02.html.