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Coding updates could affect reimbursement — 2 areas to watch in 2019

Accurate and compliant coding is essential to getting paid, so practices should keep up with requirement changes, Dermatology Times reports.

Two areas to watch:

1. Evaluation and management services. Changes in E/M services documentation and payment methodology are expected in the next couple years. Procedure codes are regularly reviewed but haven't been updated for over two decades.

The 2019 Medicare Physician Fee Schedule final rule CMS published in November 2018 included updates to documentation requirements and physician reimbursement. However, many specialists expressed concerns about the proposal, and the AMA presented an alternative option.

CMS is now considering the proposal and could choose to adopt, modify or ignore it. CMS' intentions could become clear when the 2020 Medicare Physician Fee Schedule Proposed Rule is published this summer.

2. Modifiers. CMS and other payers are closely watching appropriate use of modifiers 25 and 59. Modifier 25 — which indicates a separate E/M service performed by the same physician on the same day of the procedure or service — should not be used to collect payment for services that are considered part of the procedure code.

Some payers may change modifier 25 payment policies to reduce healthcare spending. Dermatologists submit claims with modifier 25 far more frequently than other specialties, so dermatologists are most affected by any changes.

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