Orange County Medical Society
Seminole County Medical Society
The Orange and Seminole County Medical Societies strongly encourage all of our members to take action immediately to oppose two of the proposals contained in the 2019 Medicare Physician Fee Schedule released by the Centers for Medicaid and Medicare Services (CMS). While we have received a number of concerns expressed about the proposed reduction in the number of E&M Codes, we have also received a number of complaints concerning the proposed changes to Modifier 25. We continue to comment to CMS about our concerns with this proposal and we encourage our physicians to do the same.
Your immediate attention is requested. The deadline to take action is September 10.
Our Concerns with the Reduction in the Number of E&M Codes
While we are greatly appreciative of efforts from CMS to reduce the administrative burden on physicians by reducing the number of E&M Codes from five to two, we oppose the implementation of this proposal because it could hurt physicians and other healthcare professionals in specialties that treat the sickest patients, as well as those who provide comprehensive primary care, ultimately jeopardizing patients' access to care. These physicians often end up providing more Level 4 and Level 5 visits compared to colleagues in other specialties or treating other patient populations that may utilize the 5 CPT codes on a more traditional bell curve. While CMS has proposed a mechanism for some additional reimbursement for those physicians that may be impacted more significantly, we strongly encourage CMS to take additional time to study this proposal and the potential impact on access to care for those beneficiaries that need more comprehensive services. We are willing and able to work with CMS to reduce administrative burdens on physicians but want to make sure it does not have a negative impact on patient care.
Our Concerns with the Modifier 25 Changes
Modifier 25 is currently used to protect reimbursement for an E&M service and performance of a procedure during the same patient encounter. CMS is proposing a 50% reduction in reimbursement for the service with the lower value when these two services are provided in the same visit. Currently the use of the Modifier 25 protects 100% of the reimbursement for both the E&M service as well as the procedural code.
We oppose this proposal to reduce reimbursement when using Modifier 25 as coding edits already require that in order for the use of Modifier 25 to be appropriate, the E&M service has to be of significance and unrelated to the standard decision making process for the performance of the procedure. While CMS may believe that there is duplication in resources when E&M services and a procedure are performed at the same time, the current edit already requires that these E&M services be unrelated to the decision to perform the procedure. These are additional evaluation services and medical decision making and we feel strongly they should not be subject to a 50% reduction.
If you would like additional background information on the proposed changes to Modifier 25, here is an excellent article on the issue: https://www.icd10monitor.com/cms-proposes-50-percent-reduction-in-claims-submitted-with-modifier-25
We want to make it easy for you to submit your comments to CMS
Here is the direct link for you to submit comments on this proposal directly to CMS: https://www.federalregister.gov/documents/2018/07/27/2018-14985/medicare-program-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other-revisions
Once on the page, you just click the green button to submit your comments.
The Florida Medical Association has also provided an excellent summary that can be found here: https://medone.informz.net/medone/data/images/FMANews/2018/pdfs/CMS_Call_to_Action.pdf