Home Forums Discussions Coding and Billing Consolidation of Medicare Billing Codes

Medicare appears determined to compress 99212 -99215 into a single code at a value at some midpoint of the 4.
This will be fine for urgent care clinics, but our office deals complex patients with multiple chronic comorbid conditions, transportation and mobility problems, needing multiple referrals, forms filled out, etc, etc.
We will go broke or have to stop seeing Medicare.
How is anyone else planning to cope with this??

Since I am a notorious undercoder I probably will see a benefit.
I think the short patient inconvenient version is "please make another appointment to deal with problem #2"

I have already frozen new Medicare's until they drop the E&M bomb, and lower the MIPS boom for next year. I don't think it will be all that difficult to deal with the multi-medical problems. I'll just do their list first, and just make sure I hit the high spots with my problem list. Not comprehensive, but who am I to doubt the Medicare gods?

I think for FP's it will be pretty much a wash, but if it means less time worrying about choosing codes and making sure you have all the necessary elements I'm all for it. I don't see a big change in how I handle appts since I generally try to take care of what I can in the time I've got, then ask them them come back if there's more. In other words coding isn't determining how I see patients now.

I'm in good shape for MIPS for 2019 and probably for 2020.

Well, I see that most everyone is going to adopt the obvious strategy -- fit the visit to the reimbursement.
That is no problem for me, but is going to be a serious inconvenience to geriatric patients who can't move very fast and have multiple problems.

It does mean having to see more patients in a day.
For doctors who see younger patients who have lots of time to make doctor visits, or pediatricians with parents who have freedom to take off work to take their kids to the doctor, it's no problem.

I will try hard not to make it my problem.

Getting reimbursed at a level 3.5 for all visits is going to be a problem for me as I deal with mostly older medicare patients and their usual level is 4. The biggest change will be when a medicare patient comes in for a cold 1 week before there usual chronic followup appointment. Sometimes now patients asks to combine appointments. Now answer is usually yes. Next year will be no.

As long as I can still add a 25 modifier to my visit with the Medicare Annual Wellness (MAW), should be fine. As I understand it, this will still be possible. I usually use a 99213 + MAW for most folks and once in a while a 99214 so in fact, it may be a bit more $$$ for the visit.

yes Jimmie, you can add on a E/M code to your preventive code, but they plan to reduce the reimbursement for the E/M code by 50%. That is something I hope will go away. Otherwise, we can see pts just for a AWV and have them come back for the chronic issues. Highly inconvenient for everyone and poor care, but otherwise we are just giving our time away. If this goes through we are going to need to increase the number of patients we see. Those of us who have a geriatric practice with mostly 99214s are going to suffer most. I plan to bring them back more often and spend less time with each visit, sadly. Hopefully, we can reduce the time spent documenting and see at least an extra few patients as a result.

Bill,
I should clarify what I wrote before. Often I will see fairly complex medicare patients only once yearly, and when I do I combine an Medicare Annual Wellness Visit with a 99213, most of the time and rarely a 99214. What I see happening is that I will likely see an increase in revenue because of the following...
99212--45$
99213--76$
99214--109$
99215--148$

the new proposed 99212-99215 reimbursement will be 93$

My rationale for my thought is that since I already do a lot more 99213 with the MAW, very few 99214 and no 99215, I will likely get almost an additional 20$ per visit with this change in reimbursent.
Also, the documentation should be easier to fulfill, as I understand it, the new "combined" documentation requirement will be at the 99212 level.

Jimmie,
I think what Bill was saying is that Medicare may whack down the E&M code by 50% when you do wellness visit on same day. So the $93 reimbursement for 99213.5 may go down to $46 if you do a procedure (wellness visit?) same day.
...Ken

"Pay may be cut for same-day E/M visits, procedures: CMS proposes to apply a multiple-service payment adjustment when an E/M visit is reported the same day as a procedure, similar to the long-standing multiple-procedure payment reduction for surgical and some imaging services. Under the proposal, when an E/M is reported on the same date as a procedure, Medicare would reduce payment by 50% for the least expensive service provided. In some cases, it could be the E/M service ? for example, if reported with a higher-valued procedure such as an injection. In other cases, the reduced payment could be for the procedure, such as an EKG. The proposal appears to apply to office-based services, when modifier 25 would be appended to the E/M code."
from
https://pbn.decisionhealth.com/Blogs/Detail.aspx?id=200733

Well if that happens, I will have to change my ways to replicate Bill's plan then, that proposed change makes no sense.

Looks like final rule keeps the status quo until 2021. No 50 percent reduction either.

https://www.cms.gov/newsroom/fact-s...are-physician-fee-schedule-calendar-year

Ken,
Thanks for the link. Sounds good, makes us all feel like we get a "raise" when we don't get the slash in our payments, I guess.

Ken, Thanks for the link. Looks like nothing really changes, although I won't miss the home health form saying why the pt needs home health. That is nice. Now if they could just get rid of the requirements for O2 and diabetic shoes!

Jimmie, You are exactly right. Every year they threaten to cut us in one way or another and we are all relieved when once again our real income falls as Medicare payments fail to keep up with inflation, never mind the cost of doing business.

https://www.cms.gov/newsroom/fact-sheet

A lot of that seems to me to indicate they are really thinking about how to make Medicare work better for doctors and patients.

I appreciate that.
I hope it won't be gamed by unscrupulous people, but the stakes are high, so there will always be the temptation

Tom,

The link you provided is not working.

Hi Jimmie & Tom,

There are several fact sheets here, with the most recent ones at the top:

https://www.cms.gov/newsroom/

One or more of them may be what Tom has in mind.

Cheers,

Carl Fogel

This link works. I tested it.
It is difficult to trust CMS -- but of course they have a lot of "stakeholders" to satisfy. Independent practices would seem to be near the bottom of the list, but nonetheless, if this is what they do, I thnk we can live with it.
https://www.cms.gov/newsroom/fact-s...are-physician-fee-schedule-calendar-year