New E/M codes poised to increase endocrine reimbursement, reduce paperwork
This issue of Endocrine Today introduces the Putting It into Practice column, coordinated by Jonathan D. Leffert, MD, FACP, FACE, ECNU. In the coming months, Leffert and Endocrine Today will speak with experts to discuss best advice and strategies for a healthy endocrine practice.
In this issue, Leffert talks with Susan R. Bailey, MD, president of the AMA, about the new evaluation and management (E/M) codes launching Jan. 1.
Thank you, Dr. Bailey, for leading the AMA during the coronavirus pandemic, using science and public health as your guidepost. We are grateful for your leadership and appreciate your time to respond to these important changes in our day-to-day practice. What are the major changes from the old E/M codes to the new codes?
Bailey: Foundational improvements are coming on Jan. 1 to the coding, documentation and payment of E/M services for office visits. These enhancements match the physician-led recommendations of an AMA-assembled joint work group representing the CPT Editorial Panel and the AMA/Specialty Society RVS Update Committee. Under the new guidelines for coding and documenting E/M office visit services, physicians select the appropriate code based on medical decision-making or total time on the day of the encounter. The modification eliminates history and physical exam as elements for code selection. The changes are expected to promote greater payer consistency with more detail added to CPT code descriptors and guidelines.
At this time, will these new codes be applicable to all payers or just Medicare?
Bailey: CMS will implement the revised E/M office visit codes on Jan. 1, 2021. For several months, the AMA has been working closely with commercial payers to educate them about the E/M office visit code revisions. To comply with federal regulations governing HIPAA-compliant transactions, commercial payers will adopt the E/M office visit code revisions and are already planning for implementation in 2021.
Based on the increased complexity of many patients, do you think physicians will benefit from a reimbursement perspective?
Bailey: The newly adopted office visit payment rates, and other payment increases finalized by CMS, are required by federal law to be offset by payment reductions to other medical services covered by Medicare. This will result in a 10.2% decrease to the Medicare conversion factor and payment cuts to many medical specialties. Redistributions will be significant with Medicare payment cuts of 8% or more to medical specialties that do not perform office visits, while endocrinology can expect a 16% payment increase under Medicare.
Medicare payment cuts are deeply troubling during a time when COVID-19 cases are skyrocketing and practices are already experiencing substantial economic hardships. For this reason, the AMA strongly urges Congress to prevent or postpone the payment reductions resulting from Medicare’s budget neutrality requirement.
Will these codes apply to telemedicine as well as in-office patient care?
Bailey: Currently, the simplified guidelines for coding and documenting E/M office visit services apply to telehealth and in-person visits. To facilitate telehealth, CMS issued a waiver effective during the COVID-19 public health emergency that allows health care professionals to report E/M office visit services using the simplified guidelines for selecting an appropriate code based on medical decision-making or total time on the day of the encounter.
Do you think these new codes will decrease the documentation requirements and the “hassle factors” that all clinicians face at this time?
Bailey: Reducing documentation overload and providing physicians more time with patients, not paperwork, was the fundamental purpose of overhauling the E/M office visit guidelines. Between July 2018 and July 2019, the AMA worked with CMS and convened physicians from medical specialties to simplify and streamline the coding and documentation for E/M office visits. The process is now simpler and more flexible, significantly relieving physicians and care teams from administrative burdens, time-wasting note bloat and clinically irrelevant box checking.
For several months, the AMA has been helping physicians prepare for getting the full benefit of the burden relief from the E/M office visit changes and offers authoritative instructional resources, including checklists, videos, modules, guidebooks, as well as other tools and references to help physicians adapt to the operational, infrastructural and administrative workflow adjustments that will result from the transition (See www.ama-assn.org/ practice-management/cpt).
- For more information:
- Susan R. Bailey, MD, is president of the AMA. She can be reached at American Medical Association, AMA Plaza, 330 N. Wabash Ave., Suite 39300, Chicago, IL 60611.
- Jonathan D. Leffert, MD, FACP, FACE, ECNU, is managing partner at North Texas Endocrine Center, past president of the American Association of Clinical Endocrinology. He is an Endocrine Today Editorial Board Member and the Putting It into Practice column editor. He can be reached at jleffert@leffertmail.com; Twitter: @JonathanLeffert.
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