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Breaking: CPT workgroup puts E/M code changes in its sights

Many practices are breathing a sigh of relief after CMS decided to hold off on critical payments changes for E/M services. But don’t get too comfortable just yet; an AMA committee is on track to file an application for a coding update as soon as early 2019, according to officials.
“We anticipate there will be a code change coming to the February [2019] CPT meeting,” says Kenneth Brin, M.D., AMA CPT editorial panel chair, speaking at the CPT and RBRVS 2019 Annual Symposium in Chicago. The suggested changes will still be in a preliminary phase at that point, Brin cautioned, and it remains to be seen if that initial proposal will be made public.
The fast-tracking of a revamped E/M code set, however, indicates that the AMA and its CPT panel members are determined to have a say in the future of outpatient office codes, how they’re documented and what level of payments are attached to them. Officially known as the CPT/RUC Workgroup on E/M, the committee has met multiple times in previous months to begin to hammer out a plan to build out a new code system for the oft-used outpatient codes 99201-99215, Brin says
Under CMS’ current plan, practices would see  a flattened payment rate for levels 2 to 4 codes and separate rates for levels 1 and 5 codes that would take effect in 2021. Practices also would be eligible to select the documentation standards they prefer to use from a batch of several options.
CMS officials speaking at the conference made it clear that the agency is in a wait-and-see approach and will take cues from the AMA and other industry stakeholders before the 2021 changes take hold.
CMS “is aware that the AMA workgroup is considering a wide range of issues,” says Pierre Young, medical officer with CMS’ hospital and ambulatory policy group. Young noted that the agency is “eager” to see what ideas are floated as it engages in future rulemaking that could expand on or completely overhaul the 2021 revisions.
The CPT editorial panel has previously attempted to revise the E/M code set, but gaining consensus among various specialty groups proved challenging, according to Brin. “Maybe we did need a kick somewhere,” he says.
Ultimately, the timeline on E/M changes remains uncertain, although any major payment or documentation revisions are likely to stick to the anticipated 2021 timeframe. If anything, it’s now clear that the AMA will be lending crucial input on how the changes play out.
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