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PFS Billing-Code Rules 'A Step Forward,' Says AOA

By Christopher Cheney  
   November 07, 2016

"What had happened previously was that by having services bundled into an evaluation and management visit code, it made those codes available to all specialties, which was a good thing when physicians had to do additional specialty work. But it also made it harder for primary care, which has a certain level of care beyond [face-to-face interactions with patients]."

She gave a hypothetical example of how the new codes will work. "With one of the codes for the non-face-to-face time, the physician will have to document an hour of time in order to be paid for that code. In practice, that hour could be reconciling the 20 different medications a patient is on to make sure two of them are not conflicting with each other and making the patient worse."

"That takes time. Some of it could be care coordination in terms of reaching out to other physicians and specialists that the patient is seeing, then doing follow-up and getting care plans to see whether there is any reconciling that needs to be done there. A lot of that back-end work is not part of the usual visit code."

The new PFS billing-code rule for cognitive-assessment reimbursement should help patients and give primary care practices a financial boost, Wooster says.

"One of the other codes that we were happy to see lets physicians to be paid for cognitive assessments. So, if physicians have elderly patients, they can take the time needed to do cognitive assessments to see whether patients have the early stages of senility or Alzheimer's or dementia, then physicians can get paid for taking the time to do those assessments.

"There is limited time in most visits—about 14 minutes—so the cognitive assessment code allows physicians to take the extra time and still stay in business."

The billing-code changes and other provisions of the 2017 PFS final rule are expected to increase Medicare payments to primary care practices about $140 million next year.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.

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