Evaluation and Management Changes
What Breast Surgeons Need to Know

Beginning in 2017, the U.S. Centers for Medicare and Medicaid Services (CMS) launched an effort to reduce the documentation burden associated with coding and billing for office and outpatient evaluation and management (E/M) services, both the new and established patient code sets (CPT 99201-99205; CPT 99211 – 99215). This effort initially led to a series of proposed changes, which were met with significant pushback from physicians that utilize these code sets. In response, the American Medical Association (AMA) CPT Editorial Panel and RVS Update Committee (RUC) embarked on a collaboration that resulted in the reconfiguration of the office and outpatient E/M documentation guidelines and the RVUs associated with those codes.

Last year, CMS finalized these changes (as well as others) as put forward by CPT and RUC with an effective date of January 1, 2021. These changes will replace the current 1997 and 1999 coding and documentation guidelines for office and outpatient E/M codes. However, because of statutory requirements that prohibit CMS from making changes that result in significant overall spending increases, CMS will cut the Medicare Physician Fee Schedule conversion factor to essentially claw back the significant Medicare spending increases that would otherwise result from the increased values it has assigned to the office and outpatient E/M code set (and creation of new companion codes to that code set). This alone is estimated by CMS to generate a cut in overall 2021 Medicare payments by over ‑7.0% for general surgeons, with similar cuts expected for surgical oncologists.

What action has ASBrS taken?

ASBrS has been active to ensure that your practice is relieved from documentation and administrative burdens, while simultaneously working to ensure that your practice is reimbursed at rates that reflect the resources and skills you expend to serve your patients. ASBrS has been actively working to prevent the 2021 policies from generating the cuts estimated for your practice. Examples of this activity include:

What does this mean for me next?

As mentioned, the policy is currently slated for a January 1, 2021 implementation date. Although CMS has finalized the policy and opportunities for input with the agency are limited, ASBrS and its surgical group partners are working tirelessly to pursue a legislative solution that would prevent the cuts from going into effect. While it seems that congressional talks on a COVID relief bill have broken down, Congress must extend certain other Medicare policies in November 2020 or they will expire. Thus, there is a legislative “vehicle” in the Fall in which Congress could include a legislative solution that would prevent the cuts from going into effect in 2021. ASBrS will provide additional clarity as more information becomes available.

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