CMS Proposed New E/M Codes for Podiatry

July 16th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Categories:   Evaluation & Management (E/M)   Podiatry   Relative Value Units (RVUs/RBRVS)   HCPCS Coding  
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According to CMS changes are coming for E/M codes.  A recent proposal from CMS stated: "The E/M visit code set is outdated and needs to be revised and revalued." Since podiatry tends to furnish a lower level of E/M visits, CMS is proposing new G-codes to report E/M office/outpatient visits. The proposed codes will require the same documentation standards as the visits that are currently reported for E/M when reporting for podiatry. CMS also stated; the current coding structure will remain the same except for adding new replacement codes for Office/Outpatient E/M visits. Practitioners will continue to report on the professional claim whatever level of visit (1 through 5) they believe they furnished using CPT codes 99201-99215.

NOTE: If the proposal goes through; the proposed rates would be a single rate when billing for services with E/M codes Level 2-5 E/M visits.

Podiatric Evaluation and Management Services (HCPCS codes GPD0X and GPD1X)

"We are proposing 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.

We are proposing 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. For further discussion of proposals relating to these codes, see section II.I of this proposed rule.” 

GPD0X

Proposed:

Podiatry services, medical examination and evaluation with initiation of diagnostic and treatment program, new patient.

Work RVU of 1.36, a physician time of 28.19 minutes, and direct costs summing to $21.29

GPD1X 

Proposed:

Podiatry services, medical examination and evaluation with initiation of diagnostic and treatment program, established patient.

Work RVU of 0.85, physician time of 21.73 minutes, and direct costs summing to $15.87

Changes are coming, watch for more articles and information on E/M changes. 

See the proposed rule below by Centers for Medicare & Medicaid Services (CMS), HHS files 7/12/2018 with a publication date of 07/27/2018. 

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