ATS Comments on Medicare Proposed Payment Rules
In September, in partnership with CHEST, the ATS submitted comments on the 2022 proposed Medicare Physician Fee Schedule. The proposed rule covers payment and policies for physician reimbursement under Medicare Part B services and touched on a wide range of issues of direct interest to ATS members.
Of particular note were several proposed policy changes that impact payment and documentation for critical care services. Below is a quick summary of the proposed critical care policies in the proposed rule.
Critical Care Over Midnight Rule – Critical care (CPT 99291 & 99291) is a time-based code. Under current Medicare policy, the clock stops at midnight, meaning any episode for critical care that spans midnight, must be reported as two separate critical care codes. CMS is proposing to allow critical care service that spans over midnight to now be reported on one calendar day (presumably the calendar day the critical care service was initiated). The ATS supports this proposal and urges its adoption.
Concurrent critical – Under current policy, two critical care providers cannot bill for treating the same patient at the same time. CMS is proposing to allow concurrent billing of two critical care providers, from separate physician practices, to treat different medical problems of the same critically ill patient. The ATS supports this proposal and offered suggestions on how best CMS could implement this change of policy.
E/M on same day as critical care – CMS is proposing to not pay any other E/M service provided on the same day as a critical care service (CPT 99291 & 99292). The ATS opposes this policy and in our comments noted that, while infrequent, it is not unusual or inappropriate for a patient to be seen in the office, rapidly deteriorate, and be referred to emergency room and then a critical care unit. At each step in that process, the patient is receiving appropriate care and physicians are appropriately billing E/M services.
Surgical global period and critical care – Under current policy, the critical care provided by a surgeon or physician as part of a surgical group, is often bundled into a surgical global period. However, physicians not part of the surgical group can provide and bill for critical care services provided to a surgical patient, provided the medical condition is not specific to surgery. CMS is proposing to disallow payment for any additional critical care services provided during a surgical global period. The ATS strongly opposes this policy and outlined the potential impacts such a policy would have on quality of care and financial impact on critical care providers.
Pulmonary Rehabilitation - In addition to critical care policy, CMS also responded to the newly created CPT codes for pulmonary rehabilitation (CPT 946X1 & 946X2). In the proposed rule, CMS rejected the recommended work values provided by the AMA Resource Base Relative Value Update Committee (AMA RUC) and instead proposed lower work values. While the physician work values proposed by CMS are still higher than current reimbursement provided in the existing code (G0424), the values proposed by CMS do not reflect the level of work involved in providing pulmonary rehabilitation. The ATS comments urged CMS to adopt the AMA RUC values and provided background information to support a higher work value.
In related news, the ATS and CHEST also submitted comments on Hospital Outpatient Prospective Payment proposed rule. The comments expanded on our support of the pulmonary rehabilitation CPT codes and provided our rationale for higher reimbursement rates for pulmonary rehabilitation services.
