Awareness : OBC Tips

Changes to the Medicare Physician Fee Schedule for 2019: Reducing Clinician Burden

On November 1, 2018, the Centers for Medicare & Medicaid Services (CMS) issued the documentation, coding, and payment changes listed below to reduce administrative burden and improve payment accuracy for office/outpatient evaluation and management (E/M) visits for services furnished under the Medicare Physician Fee Schedule on or after January 1, 2019.

  • For E/M office/outpatient visits for new (99201-99205) and established (99212-99215) patients, billing practitioners do need not re-enter in the medical record information on the patient’s chief complaint and history (ALL aspects of History: chief complaint, HPI, ROS, PFSH), that has already been entered by ancillary staff or the beneficiary. Instead, the billing practitioner can review the information, update and supplement as necessary, and document that the information has being reviewed and verified by the billing practitioner.
  • For established patient office/outpatient visits, when relevant information is already contained in the medical record, practitioners may choose to focus their documentation on what has changed, since the last visit, or on pertinent items that have not changed, and need not re-document the defined list of required elements if there is evidence that the billing practitioner reviewed the previous information and updated it, as needed.  Practitioners should still review prior data, update as necessary, and indicate in the medical record that they have done so.

As per First Coast Service Options (FCSO), this only applies to the E/M codes.  It does not apply to any other codes, such as the Eye codes (92002,92004 and 92012, 92014).