Podiatry Billing Services

CMS Proposes HCPCS G-codes for Podiatric E/M Visit Payment Scheme

In July 2018, CMS has proposed a major reworking of its evaluation and management (E/M) visit payment scheme to reflect more accurately the resources used in different types of care. They have proposed to create two HCPCS G-codes, HCPCS codes GPD0X (Podiatry services, medical examination, and evaluation with initiation of diagnostic and treatment program, new patient) and GPD1X (Podiatry services, medical examination, and evaluation with initiation of diagnostic and treatment program, established patient), to describe podiatric evaluation and management services.

CMS has proposed a work RVU of 1.36, a physician time of 28.19 minutes, and direct costs summing to $21.29 for HCPCS code GPD0X, and a work RVU of 0.85, physician time of 21.73 minutes, and direct costs summing to $15.87 for HCPCS code GPD1X. These values are based on the average rate for CPT codes 99201-99203 and CPT codes 99211-99212 respectively, weighted by podiatric volume. The update is described in CMS’ Notice of Proposed Rulemaking, titled “Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2019,” which will be published in the Federal Register on July 27, 2018. Major takeaways are listed as follows:

  • The vast majority of podiatric visits are reported using lower level E/M codes, with most E/M visits billed at a level 2 or 3, reflecting the type of work done by podiatrists as part of an E/M visit. Therefore, while the proposed consolidation of documentation and payment for E/M code levels 2 through 5 is intended to better reflect the universal elements of E/M visits across specialties and patients, CMS believes that podiatric E/M visits are not accurately represented by the consolidated E/M structure.
  • In order for payment to reflect the resource costs of podiatric visits, CMS is proposing to create two HCPCS G-codes, HCPCS codes GPD0X and GPD1X to describe podiatric E/M services. Under this proposal, podiatric E/M services would be billed using these G-codes instead of the generic office/outpatient E/M visit codes (CPT codes 99201 through 99205 and 99211 through 99215).
  • CMS proposes to create these separate G-codes for podiatric E/M services to differentiate the resources associated with podiatric E/M visits rather than proposing a negative add-on adjustment relative to the proposed single payment rates for the generic E/M levels 2 through 5 codes.
  • Based the coding structure and code descriptor on CPT codes 92004 (Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, 1 or more visits) and 92012 (Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient), which describe visits specific to ophthalmology.
  • To accurately reflect payment for the resource costs associated with podiatric E/M visits, CMS has proposed a work RVU of 1.35, a physician time of 28.11 minutes, and direct PE inputs totalling $22.53 for HCPCS code GPD0X, and a work RVU of 0.85, physician time of 21.60 minutes, and direct PE inputs totalling $17.07 for HCPCS code GPD1X. These values are based on the average rate for level 2 and 3 E/M codes (CPT codes 99201- 99203 and CPT codes 99211-99212, respectively), weighted by podiatric volume.

In Podiatry billing, there is always a challenge to making sure the evaluation and management codes are reimbursed separately rather than bundled together for one payment. Medical Billers and Coders (MBC) have experienced podiatry billing experts who remain on top of these billing updates all the time. This allows us to submit a clean claim the first time, which improves timely claim processing. In addition, when claims are denied by an insurance carrier, we have the ability to quickly review and have those claims immediately reprocessed. MBC is a premier provider of healthcare revenue cycle management services providing quality services along with cost reduction. Contact us on (888) 357 3226 or Email us info@medicalbillersancoders.com to know more about our Podiatry medical billing and coding services.

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