CMS delays controversial E/M changes in final rule


After a torrent of criticism from the physician community, the Centers for Medicare & Medicaid Services has delayed its proposed collapsing of evaluation and management (E/M) codes into single payments.

Dr. Orly Avitzur

Dr. Orly Avitzur

The agency’s final 2019 Physician Fee Schedule, announced Nov. 1, rescinds a proposal that would have blended payments for new and established patients for office/outpatient E/M levels 2 through 5 into single payments. Instead, the agency will continue to hear perspective on the proposal with plans to collapse E/M code levels 2 through 4 into single payments beginning in 2021, while maintaining level 5.

CMS also pulled back its proposal to apply a multiple procedure payment reduction to E/M visits furnished on the same day as a procedure. Payment rates for the less expensive of the two will be maintained, rather than cut in half as initially proposed.

The final rule released is much different than the one proposed, which shows that CMS heeded concerns by physicians and took time to craft a more realistic fee schedule, said Orly Avitzur, MD, chair of the American Academy of Neurology’s Medical Economics and Management Committee. The proposed collapsed E/M levels would have likely led to shorter visit times, negatively impacting the doctor-patient relationship and patient care, she said.

As part of its final rule, CMS moved forward with several other changes to coding and documentation, including eliminating the need to document the medical necessity of a home visit in lieu of an office visit, and allowing physicians to skip documentation of changes since a prior patient visit when relevant information is already contained in the record.

Additionally, the final rule clarifies that for E/M office/outpatient visits physicians do not need to re-enter information on the patient’s chief complaint and history that has already been entered by ancillary staff or the patient. The physician may just indicate in the medical record that he or she has reviewed and verified the information.

In a statement, CMS administrator Seema Verma said the final rule cements dramatic improvements for clinicians and patients and reflects extensive input from the medical community.

“Addressing clinician burnout is critical to keeping doctors in the workforce to meet the growing needs of America’s seniors,” Ms. Verma said in the statement. “[The] rule offers immediate relief from onerous requirements that contribute to burnout in the medical profession and detract from patient care. It also delays even more significant changes to give clinicians the time they need for implementation and provides time for us to continue to work with the medical community on this effort.”

“In the final rule, CMS acknowledges concerns from physicians regarding many aspects of the proposed rule,” said Anton Decker, MD, chair of the American Gastroenterological Association’s Practice Management and Economics Committee. “In particular, proposed revisions to E/M services would have negatively impacted the doctor-patient relationship and patient care, especially for the most complex patients,” he said.

“Overall, the AGA is pleased that CMS listened to concerns and reversed certain proposals such as the multiple procedure payment reduction for E/M visits furnished on the same day as a procedure,” Dr. Decker said. “We are also pleased that CMS is giving stakeholders an additional 2 years to provide input on how best to refine E/M documentation and coding.”

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