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Doctors advocate overhauling some Medicare billing codes

Modern Healthcare- By Virgil Dickson  | March 22, 2018

Lowering documentation standards for a commonly used set of billing codes would lead to better quality of care, doctors told the CMS during a conference call Wednesday.

Most physicians bill Medicare for patient visits under a relatively generic set of codes that distinguish the level of complexity and site of care. They are called evaluation and management visit codes. The last significant update to the E/M guidelines was more than 20 years ago.

“The agency has heard repeatedly over the years that these documentation guidelines are potentially outdated and need to be revised,” Marge Watchorn, deputy director of CMS’ Division of Practitioner Services, said during the call which was hosted by the agency to request input from the provider community.

The codes were developed with a paper-based system in mind, said Dr. Paul Rudolf, a partner at Arnold & Porter who represents the American Geriatrics Society.

Clinicians currently must provide a comprehensive medical history each time they submit a claim. They’d rather document why a patient is receiving care in a specific instance of treatment.

“There is now somewhat of a perverse incentive that ordering more tests will meet medical decision-making” standards, said Dr. Thomas Sugarman, an emergency medicine doctor at Sutter Delta Medical Center in California.

Requirements around E/M also make it harder to bill for more-intensive office visits for some of the sickest patients. The codes “disincentivize addressing multiple chronic conditions in one visit, which is something we would very much like to do,” said Dr. Lindsay Botsford, a family physician at Memorial Hermann Health System in Houston.

The CMS first announced its intentions to review E/M guidelines for the 2018 Medicare physician fee schedule rule. Watchorn said feedback from comments on that rulemaking and the call will inform an update on the guidelines.

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