A change in government payment policy for dermatologists and other physicians in selecting office coding and billing for evaluation and management (E/M) is scheduled to begin January 2021.
“The Centers for Medicare & Medicaid Services (CMS) decided over a year ago that it wanted a decrease in the documentation burden on the physician,” said Mark Kaufmann, M.D., an associate clinical professor of dermatology at Icahn School of Medicine at Mount Sinai in New York. “CMS proposed creating a new coding system with fewer codes, thereby creating less of a differential and less work that would need to be done by the physician to choose a code when it came to judging a patient’s office visit and the way they would bill that visit.”
CMS provided a timeline to institute the change, in order to allow the American Medical Association (AMA), the Current Procedural Terminology (CPT) code and the AMA’s Relative Value Scale Update Committee (RUC) to come up with an alternative plan. This past July, CMS proposed to institute this alternative plan.
“The codes remain the same, except for the deletion of one of the E/M codes, but the way that we choose the codes has changed,” says Dr. Kaufmann, who spoke on pending healthcare policy changes relevant to the practicing dermatologist in August at the annual meeting of the Pacific Dermatologic Association in San Diego. “The change in coding will require a re-education of all clinicians in the country over the next 12 months. However, I believe this change in the paradigm for the way we code office visits will be a net positive for the specialty.”
Dr. Kaufmann expects the coding changes to be finalized in November; yet they will likely not take effect until January 2021.
The new coding will be predicated on either time or medical decision making (MDM). “Currently, everyone counts the number of bullet points in their notes that are related to patient history and physical examination,” Dr. Kaufmann said. “Those bullet points will no longer be necessary for billing purposes, although some may be required for good medical care and for medical liability reasons.”
Dr. Kaufmann expects that most dermatologists will use MDM rather than time as their code determinant.
Modifier 25 is a second potential hurdle for the field of dermatology. “This is a billing situation when we do a procedure on the same day as an office visit,” Dr. Kaufmann says. “Presently, we actually have to identify the office visit with the 25 modifier as being separate from the procedure, in order to be paid for both.