The Centers for Medicare & Medicaid Services (CMS) released the Medicare Physician Fee Schedule (PFS) Final Rule on Oct. 30, 2015. It addresses changes to the physician fee schedule as well as other important Medicare Part B payment policies. The rule became effective Jan. 1, 2016, and was published in the Nov. 16, 2014, Federal Register. Last month, we reviewed changes to Medicare payments and incentive programs. This month, we’ll look at some coding changes for 2016.

Proposal to Eliminate the Global Surgical Package for Procedures

CMS has previously proposed to eliminate the 10-day global and 90-day global packages for many procedures. The relative value units (RVUs) and payments for affected procedures would be lowered substantially because the procedures would not include any bundled follow-up care as part of the payment for the initial procedure. CMS originally proposed to make this transition for procedures that have a 10-day global period in 2017 and for procedures that have a 90-day global period in 2018. The methodology for recalculating the RVUs associated with broad, sweeping changes to the global surgical packages has proven to be complicated, and CMS has softened the exact timeline. If the global surgical package were phased out, ED providers would continue to bill for procedures, such as incision and drainage, joint reductions, etc., but the RVUs would be significantly reduced. However, if a patient returns to the ED for additional care, the opportunity might exist to report a 9928x E/M level for associated follow-up visits.

On Oct. 1, 2016 (one year after implementation of ICD-10), regular updates to ICD-10 will begin. The ICD Coordination and Maintenance Committee will continue to meet twice a year during this partial freeze.

The Fee Schedule included the following statement about next steps in evaluating global surgical packages:

“We appreciate the extensive comments we received from the public regarding the global surgical package. We have noted the positive feedback from commenters about holding potential open forums or town hall meetings to discuss this process. We will consider these comments regarding the best means to develop and implement the process to gather information needed to value surgical services as we develop proposals for inclusion in next year’s [2017] PFS proposed rule.” —MPFS Final Rule 114/1358

2016 CPT Coding Changes

The Current Procedural Terminology (CPT) book is published annually, and for 2016, there are 92 deletions, 134 revisions, and 140 CPT code additions, totaling 366 changes. The code changes impacting emergency medicine are listed below.

The Following Code Has Been Added for 2016

69209 Removal impacted cerumen using irrigation/lavage, unilateral Significant specific direction is also provided:

• For removal of impacted cerumen requiring instrumentation, use 69210.
• For cerumen removal that is not impacted, use an E/M service code.
• Do not report 69209 in conjunction with 69210 when performed on the same ear.
• For bilateral procedure, report 69209 with modifier 50.

Significant Changes to Pelvic and Hip X-Ray Codes

Deleted: 73500 Radiological examination, hip, unilateral; 1 view

Deleted: 73510 Radiological examination, hip, unilateral; complete, minimum of 2 views

New Codes

73501 Radiological examination, hip, unilateral, with pelvis when performed; 1 view

73502 Radiological examination, hip, unilateral, with pelvis when performed; 2–3 views

73503 Radiological examination, hip, unilateral, with pelvis when performed; minimum of 4 views

ICD-10 update

On Oct. 1, 2015, there was scheduled to be only limited code updates to the ICD-10 code set to capture new technologies and diagnoses as required by section 503(a) of Pub. L. 108-173. There will be no updates to ICD-9-CM since it will no longer be used for reporting.

On Oct. 1, 2016 (one year after implementation of ICD-10), regular updates to ICD-10 will begin. The ICD Coordination and Maintenance Committee will continue to meet twice a year during this partial freeze. At these meetings, requests for new diagnosis or procedure codes will be driven by the criteria of the need to capture a new technology or disease. Any code requests that do not meet the criteria will be evaluated for implementation within ICD-10 on and after Oct. 1, 2016, once the partial freeze has ended.

Other Resources

Resources for these and other topics can be found on the reimbursement section of the ACEP website. Mr. McKenzie is also available to field your questions at 800-708-1822, ext. 3233. Finally, ACEP offers well-attended and highly recommended coding and reimbursement educational conferences annually, with an offering each January.

Dr. Granovsky is president of LogixHealth, an ED coding and billing company, and currently serves as the course director of ACEP’s coding and reimbursement courses as well as the Chairman of ACEP’s National Reimbursement Committee. Mr. McKenzie is reimbursement director for ACEP.