Pressure pays off in E/M change discussions

HCFA delays code alterations

With some 60% of audited claims being denied under new evaluation and management rules (E/M) (see Practice Marketing & Management, May 1998, p. 57), physician groups around the country stepped up pressure on the Health Care Financing Administration (HCFA) to change the rules. Well, that pressure appears to have paid off as HCFA has extended the deadline for switching to the new coding requirements to October - or possibly next January.

Meanwhile, the American Medical Association's (AMA) CPT educational panel took up the issue at its meeting in May and says it is open to "any and all suggestions to revise the documentation guidelines."

One lobbyist for a specialty association told PMM that HCFA officials have indicated they would accept any suggested changes that the AMA's CPT educational panel comes up with.

Simplification seems necessary. According to Robert Dougherty, the American Society of Internal Medicine's vice president for government relations, the new requirements are so complex, that physicians question whether the process that goes into making billing decisions is becoming more complicated than medical decision making.

According to one study at the society, there are 42 choices providers much consider just to select the proper level of E/M service. Omit the values for the overall history, overall physical, and overall medical decision making, and you still have 6,144 possible ways an office visit for a new patient could be classified under the proposed system.

"We feel reporting the proper E/M code is so complicated under the new guidelines that physicians are always at risk of making inadvertent coding errors, which can trigger a whole new set of problems in this age of intense scrutiny of claims for fraud and abuse," Dougherty says.