CMS proposes to shake things up

August 20th, 2018 / By Rebecca Caux-Harry

By now, you’ve undoubtedly seen the CMS proposal to overhaul the E/M documentation and coding guidelines for new and established office visits, along with consolidated payments. There are articles and blogs all over the internet with the details and opinions about the proposal. Here’s another one.

CMS is seeking comments from stakeholders about the proposed updates until September 10. To submit a comment, click here. This page will also allow you to read the 1500+ comments already submitted. 

For those of us that have been in the professional coding world for a while, we’re well acquainted with the current sets of documentation guidelines published in 1995 and 1997. Fast forward 20+ years, and CMS is now proposing to consolidate the payments, but not the codes, into four values and give providers relief on the documentation requirements. Those 4 values are for 99211, 99212-99215, 99201, and 99202-99205.

I say “relief” because I believe the requirements are very burdensome to providers, without adding much, if any value. I have performed countless audits over my many years in coding. My job was to know the guidelines inside and out and provide a palatable interpretation to providers seeking direction on documentation and coding.  Not and easy, or pleasant thing to do. Then there were the auditing/education/feedback meetings I had with providers. They would politely, or not so politely, listen to my feedback about their notes and coding. Then they would go on with their very full schedule and usually not change their process one bit. They were caring for their patients and I was interrupting their day. And somehow, I managed to feel hurt when they didn’t care much about my feedback. I couldn’t see their side of things. I was concerned about compliance and doing my job well. 

As a coder, I recognize that these proposed changes could impact me greatly. If most office E/M codes are reimbursed the same amount, providers no longer need my help coding the levels. The need for auditing office E/M codes essentially goes away. Risk of over and under coding is eliminated. Practices can streamline their process of submitting these claims. We still need to insure proper ICD coding, but the compliance risk associated with physician-selected E/M codes in the office is practically eliminated. And what about “note bloat?” We’ve all heard physicians complain about the length of medical documents and the large amount of unnecessary data making finding the relevant data a challenge. If all of this goes away, what is that worth?  How much physician time can be freed up by these changes?

I spent some time yesterday reading many of the submitted comments on the CMS website. I was surprised that the majority of those comments were negative and focused almost exclusively on the consolidated payments. I had assumed that the streamlined clerical process, and reduction in compliance risk would balance the change in payments. I had assumed that physicians would be so relieved by the reduction in paper work that there would be many comments supporting that portion of the proposal. I was wrong. There were some comments supporting the proposed changes, stating the overhaul of requirements was long overdue.  But, the financial impact seems of greatest concern.

If I were a betting person, and I’m not, I would bet we’ve got at least until 2020 before this proposal makes it into the Final Rule, if ever. That extra year would give commercial payers time to decide if they will follow CMS’ example. If they don’t, we have added complexity, just like coding for consults. The AMA will also have time to update the E/M codes, if needed. What happens in the meantime, though? Will CMS still audit and fine practices for inaccurate coding? And what about E/M services outside of the office? I suspect that CMS would like to extent this change to all service locations, but is starting where the volume and impact will be felt the most. 

We have less than a month to submit comments to CMS about this proposal.  Please make your voices heard.

Rebecca Caux-Harry, CPC, is the CodeRyte product specialist for cardiology with 3M Health Information Systems.