The information provided here applies to Medicare coding. Be sure to check with your Medicare Administrative Contractor (MAC) for additional information and clarification on these and other items. You should also contact your local insurance carriers to determine if private insurers follow Medicare's lead on all coding matters.
Preparing for Changes to Coding in 2016
Effective January 1, there are a number of changes to evaluation and management (E&M) codes as well as procedural codes that could impact your reimbursement in 2016. Following are a few highlights for your consideration:
- New add-on code for optical microscopy
- Clarification of what constitutes an incomplete colonoscopy and what modifier to use for reduced service
- New code for Clinical Staff Prolonged Care services
- New code for removal of impacted cerumen with washing/lavage
- Endobronchial ultrasound (EBUS) is combined into bronchoscopy codes for transbronchial biopsies and needle aspirations
- Clarification of documentation requirements for procedures done with image guidance or supervision
- A number of new codes for 2016 are the result of combining codes that are commonly billed together resulting in a lower reimbursement because of efficiencies attained through the combination of the new codes
- Reimbursement for the counseling and discussion of advanced care directives
- Medicare continues to promote the change to evidence-based care through “appropriate use criteria”
- The Value-Based Modifier adjustments will begin in 2016 for physicians in groups with 10 or more Eligible Professionals (EPs) based on 2014 performance reporting
- Coding for GI services last year was done using “G” codes created by Medicare. In 2016, you use the codes that were issued in 2015.
- Medicare will cover Cologuard testing (a stool DNA test) under certain guidelines
- The new place-of-service 19 code for “off campus-outpatient hospital” care and its appropriate selection based on the 250-yard rule from a hospital main campus was explained in detail. Use of this code affects supervision requirements for non-physician practitioners.
In addition to the changes listed above impacting your practice, as well as many others, ICD-10 implementation is now well underway. While I have not heard of any major problems to date, I encourage you to examine your revenue flow to ensure that you are not caught off guard by any surprises. If you or someone in your office is not monitoring this, you should consider doing so immediately.