ONC, CMS taking aim at Evaluation and Management coding

The Office of the National Coordinator for Health Information Technology is working with the Centers for Medicare and Medicaid Services to reduce the burden of Evaluation and Management guidelines on physicians.

E&M coding is the process by which physician-patient encounters are translated into five-digit Current Procedural Terminology (CPT) codes, which are submitted to insurers for payment. Many in the industry contend that the coding requirements result excessive documentation, reducing the usefulness of electronic medical records because of the amount of verbiage contained in text documentation.

However, National Coordinator for HIT Donald Rucker, MD, told an audience last week at the annual American Medical Informatics Association symposium in Washington that E&M codes are leading to a lot of “chart bloat (and) very little, if any, transmitted information—the information is almost camouflaged by the size of the templates and the requirements.”

According to Rucker, the E&M codes were “actually asked for by clinicians back in 1995” as a means to ensure that documentation of services could be externally verified in order to receive reimbursement. Developed by Congress, the guidelines are regulated and maintained by CMS, and are used by all public and private health payers. But Rucker believes they are now outdated and counterproductive.

While the ONC chief acknowledges that “those things made sense when we were doing paper charts,” he contends that “they don’t make sense when we’re doing electronic records,” adding that E&M codes are “distorting what we do in American healthcare.”

As a result, Rucker said that CMS Administrator Seema Verma is “extremely interested in this problem,” and that ONC and CMS are “working to try to figure out which of these things are policies that we can address, that we can fix.” He added that Deputy Assistant Secretary for Health Technology Reform John Fleming, MD, a family physician, is the point man for reducing the regulatory and administrative burdens on providers related to the use of electronic health records.

Also See: CMS announces new ‘Meaningful Measures’ initiative

Earlier this year, the American College of Physicians (ACP) published a position paper with a set of policy recommendations on reducing excessive administrative tasks, including E&M codes.

“Although organized medicine initially supported the development of these guidelines as a means to ensure that documentation of cognitive services could be externally verified, these rules have since been implemented in a manner that is difficult to understand and use, and even counterintuitive,” states the position paper. “For example, determining the ‘level of service’ to code and bill for is overly complex and time consuming because of ambiguity among the five levels of service defined in the E&M documentation.”