CMS' proposed 2019 Medicare Physician Fee Schedule would cut reimbursement significantly for specialty physicians' most complex cases, ICD10Monitor reports.
Here are five insights:
1. The proposed changes affect evaluation and management coding for office and outpatient visits.
2. The proposal is intended to reduce paperwork and allow physicians to spend more time with patients, but it involves lowering reimbursement for complex cases often seen by specialty physicians.
3. For instance, if an endocrinologist assigns CPT code 99215 to a visit by a patient with altered mental status, four established diagnoses, a life-threatening chronic illness and other complexities, reimbursement would be $93 under the new rule. The same code resulted in $148 under the previous rule.
4. The previous rules were based on history, exam and medical decision-making, whereas this proposed rule focuses on medical decision-making. This change drastically increases pressure on physicians to provide detailed documentation supporting the complexity of deciding on a diagnosis.
5. The proposed rules are under review. Comments can be submitted here to CMS by midnight Sept. 10.
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