The CMS is hosting a conference call Wednesday to hear physicians' opinions on how certain billing codes and procedures can be updated.
Most physicians bill Medicare for patient visits under a relatively generic set of codes that distinguish level of complexity and site of care. They are called evaluation and management visit codes.
As the agency ponders some revisions, physician feedback will help staff figure out how "to reduce burden and better align coding and documentation with the current practice of medicine," according to a notice for the call. The CMS first announced its intentions to review E/M guidelines for the 2018 Medicare physician fee schedule rule; the call is a follow-up to that announcement. The last significant update to the E/M guidelines was in 1997.
A leading concern has been documentation standards, according to Dr. Jonathan Leffert, president of the American Association of Clinical Endocrinologists. A comprehensive medical history shouldn't always be necessary when submitting a claim. "Current documentation guidelines require physicians to include a variety of additional information simply to justify code selection as opposed to prioritizing documentation relevant to the patient's current and future treatment," Leffert said in a comment letter.
Dr. John Meigs, board chair of the American Academy of Family Physicians, said current documentation guidelines do little to support patient care. "Instead, they serve more as a crutch to justify billing levels than to help physicians diagnose, manage, and treat patients," Meigs said in a comment letter. He also noted that E/M guidelines were drafted for use with paper-based medical records and do not reflect the current use and further potential use of electronic health records or team-based care.
The Association of American Medical Colleges would also like the E/M standards for time spent with a patient removed, according to Dr. Janis Orlowksi, its chief healthcare officer. The agency should avoid bright-line determinations that X amount of time indicates a certain level of service, Orlowski noted in a comment. It should also recognize that time spent face-to-face with a patient does not capture the medical decisionmaking, which also includes time spent reviewing lab results, reviewing old medical records, calling or e-mailing the patient, or coordinating with other providers.