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Benchmark of the Week
Nurse practitioners (NP) will find it easier to report visits in the domiciliary and home settings when the next E/M update goes into effect Jan. 1, 2023. The update will delete the code family for domiciliary, rest home and custodial care services (99324-99337) and fold the services into the home services family (99341-99350). That code family will be renamed “home or residence services.”
The almost 4% proposed cut to the 2023 conversion factor would, if finalized, have a powerful negative effect on many of the most-used Part B procedure and E/M codes. Factoring in changing relative value units (RVU) reveals some big winners and losers on a per-service basis.
Physician practices are facing a 4% cut to the conversion factor in CY 2023, and the fee losses are evident when looking at a list of high-volume procedures and services. For non-facility rates, only two of the nearly two dozen services on this list will see larger payments in the new year, according to a review of data CMS shared as an addendum file to the proposed 2023 Medicare physician fee schedule.
As providers brace for a nearly 4% cut to the 2023 conversion factor, the impact of relative value unit (RVU) changes on specialties is projected to fluctuate from a 5% gain for infectious disease to a -4% drop for interventional radiology.
The next E/M update will affect 69 codes from five code families and will go live in less than six months. Part B News analysis of Medicare Part B claims for 2019 and 2020 reveals that frequently billed E/M services in three of the impacted code families — inpatient hospital, emergency department and nursing facility services — exceeded several office/other outpatient codes.
Use of modifier 78 (Unplanned return to the operating room by the same physician following initial procedure for a related procedure during the postoperative period) has been in decline for some time. In 2020, as COVID depressed utilization across the board, 78’s claim numbers continued to decline — while its denial rates soared.
Practices were far more likely to report a right- or left-side service over a bilateral procedure in 2020, although they faced a bit more resistance in getting their side-specific claims paid than before.
When the AMA replaced 10 temporary category III codes with 14 permanent category I codes in 2019, providers generally — but not always — boosted their reporting of the replacement codes. The category III codes, also known as T codes, were carrier-priced, which means that each Medicare administrative contractor (MAC) decides whether it will cover the service and how much it will pay on a case-by-case basis. Permanent codes are usually assigned an active payment status.
Much like standard E/M office visits, lab tests and other services, separately reported postoperative patient encounters took a sharp dive in 2020 as practices grappled with the first wave of the COVID-19 public health emergency (PHE).
Most of the 16 top-billed preventive service codes fell off of their usual pace of utilization in 2020, the first year of the COVID-19 pandemic that overturned many historical claims norms.


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