The much-anticipated coding payment and consolidation changes related to Evaluation and Management (E/M) are on hold based on input from the American Medical Association (AMA) and other professional organizations. Additional evaluation is required. 

However, changes to documentation requirements will take effect on January 1, 2019. These documentation changes are expected to help cut down on redundancy and leave more time for patient care.

Provider Documentation

Providers, including teaching physicians, will no longer need to redocument information already obtained and recorded by the student. Although the chief complaint will no longer need to be reentered by the provider, the provider is required to document that the information was reviewed.

Home Visits

Documentation of medical necessity for a home visit will no longer be necessary. The definition of “home” has been clarified and expanded to include temporary lodging and short-term accommodations. Examples given by AMA include hotels, campgrounds and cruise ships.

Future E/M Changes

The CPT/RUC Workgroup on E/M will be submitting a code change proposal to the CPT Editorial Panel in February 2019.

In 2021, the reimbursement rates are expected to change by collapsing E/M code levels 2 through 4 into one single rate and leaving Level 5 E/M as the highest level of evaluation.

CMS is pushing forward with technology use. Two new HCPCS codes and two new CPT codes were released allowing for payment of virtual check-ins and for evaluation of images that have been remotely submitted by the patient. Those services must feature –

  • Established patients (copayments will still apply).
  • Consent for the service is received and documented in the patient’s chart.
  • NOTE: If the check-in or image evaluation takes place within 7 days after an office visit or if the encounter results in an in-person visit within 24 hours (or soonest available), the service will not be billable.
coding-alert

Other Changes for 2019

Along with these expected and planned documentation changes in the Evaluation and Management section of CPT, a plethora of changes has occurred throughout the listings of codes –

  • 212 new
  • 50 revised
  • 73 deleted

Only one addition in the vaccine section (quadrivalent influenza for pediatric patients) is occurring.

However, several changes were made to the adaptive behavior codes by assigning Category I codes for several services, including –

  • Supervision of the Radiologist Assistant has been updated for diagnostic testing

The role of Physical Therapy Assistant and Occupational Therapy Assistant have changes coming during the next two years in the areas of both coding and payment.

With the impetus of CMS toward the adoption of technology and the reduction of paperwork, many significant changes are anticipated in the next several years.