02 Aug CMS Backs Down from E/M Code Reduction

In a fact sheet released on July 29, the Centers for Medicare & Medicaid Services (CMS) appeared to have reversed its earlier announcement of a reduction in evaluation and management (E/M) office visit CPT codes.

In 2018, the agency proposed collapsing the number of E/M codes for new and established patients from five to two, spurring backlash from physicians’ organizations and other healthcare groups. While the original stated intent of the shift was to reduce the onerous documentation burdens faced by physicians and clinicians, the end result appeared to be a reduction in overall physician payments for non-procedural specialties.

The new Proposed Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2020 retains established patient office visit E/M codes 99211-99215, while reducing the number of new patient levels to four. This move aligns with recommendations from the AMA’s CPT Editorial Panel.

The new proposal maintains support of a reduction in documentation requirements for E/M visits, where the level of service may be determined by either the time spent with the patient or the level of medical decision making. Performance and documentation of the history and physical exam is only required as medically appropriate, where historically, documentation of both was required for all levels of service.

If all is as appears, this is an encouraging shift in the approach to payment for medical services, particularly for primary care specialties. We’re also curious if these changes will help reduce the problems with “note bloat,” and allow charting to return to its original purpose of tracking relevant changes in a patient’s health and medical conditions. We’ll be watching closely for further developments.

You can read more about this new proposal, along with other changes HERE.

1Comment
  • Would you look at the time... - speroMD
    Posted at 10:33h, 09 August Reply

    […] discussed some potential changes in E/M visit leveling in last week’s blog. One key point was that the amount of time spent face-to-face with the patient could be used as the […]

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