The Medicare Physician Fee Schedule (MPFS) 2017 Final Rule offers some big updates related to global periods, non-face-to-face services, telehealth, and moderate sedation coding, among others, according to the Centers for Medicare and Medicaid Services (CMS) when it released the rule Nov. 2.

For instance, the MPFS rule addresses the agency’s efforts to collect data about global periods, which is mandated by the Medicare Access and CHIP Reauthorization Act (MACRA). Initially, CMS planned to require you to use new G codes to gather information about global period-related services. But those have been pushed to the side in favor of an existing CPT® code (99024, Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure). The hope is that this will reduce the burden on you and your practice.

In addition to using an existing code to keep things simpler for this data-gathering effort, the MPFS also stated the following:

• You only have to report postoperative visits for high-volume/high-cost procedures
• Only large practices (10 or more practitioners) in specific states (Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon, and Rhode Island) must report these visits
• If your practice is smaller or isn’t in one of the listed states, then you can still report voluntarily.

CMS has also targeted 19 services with zero-day global periods for review that it feels are potentially misvalued because they are frequently reported with E/M services and a modifier for separate payment. Those services include the following:

• 11755 — Biopsy of nail unit (eg, plate, bed, matrix, hyponychium, proximal and lateral nail folds) (separate procedure)
• 20526 — Injection, therapeutic (eg, local anesthetic, corticosteroid), carpal tunnel
• 20551 — Injection(s); single tendon origin/insertion
• 20612 — Aspiration and/or injection of ganglion cyst(s) any location
• 29105 — Application of long arm splint (shoulder to hand)
• 29540 — Strapping; ankle and/or foot
• 29550 — Strapping; toes
• 43760 — Change of gastrostomy tube, percutaneous, without imaging or endoscopic guidance
• 45300 — Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)
• 57150 — Irrigation of vagina and/or application of medicament for treatment of bacterial, parasitic, or fungoid disease
• 57160 — Fitting and insertion of pessary or other intravaginal support device
• 58100 — Endometrial sampling (biopsy) with or without endocervical sampling (biopsy), without cervical dilation, any method (separate procedure)
• 64405 — Injection, anesthetic agent; greater occipital nerve
• 64455 — Injection(s), anesthetic agent and/or steroid, plantar common digital nerve(s) (eg, Morton’s neuroma)
• 65205 — Removal of foreign body, external eye; conjunctival superficial
• 65210 — Removal of foreign body, external eye; conjunctival embedded (includes concretions), subconjunctival, or scleral nonperforating
• 67515 — Injection of medication or other substance into Tenon’s capsule
• G0168 — Wound closure utilizing tissue adhesive(s) only
• G0268 — Removal of impacted cerumen (one or both ears) by physician on same date of service as audiologic function testing

In addition, the agency used the MPFS rule to finalize a number of coding and payment changes related to primary care, care management and cognitive services:

• There will be separate payment for certain non-face-to-face prolonged evaluation and management (E/M) services CPT® codes (99358-99359).
• CMS revalued existing codes that describe face-to-face prolonged services.
• You can use — and be paid for — a new code (G0505) that represents comprehensive assessment and care planning for patients with cognitive impairment.
• Medicare will pay primary care practices separately (using new codes G0502-G0504) when they use interprofessional care management services to treat behavioral health patients. This includes coordinating care between the primary care physician and the behavioral health care provider.
• Chronic care management (CCM) for patients with greater complexity has its own codes (99487-99489).
• CMS reduced the CCM administrative burden to alleviate some of the burden of furnishing and billing for these services.

The agency also finalized values for the new CPT® moderate sedation codes (99151-99157) and adopted a uniform methodology for valuation for those codes that currently include moderate sedation as a part of the procedure. Along the same line, CMS is adding an endoscopy-specific moderate sedation code (G0500).

There are also several new codes for those services you provide using telehealth:

• End-stage renal disease (ESRD)-related services for dialysis (90967)
• Advanced care planning services (99497-99498)
• Critical care consultations (these use new codes G0508-G0509).

CMS also finalized how you will use a new place of service (POS) code (02) that has been specifically designed to report any services provided through telehealth. But this new POS code will not mean that you can bypass modifiers GT and GQ, which certify that a service meets the telehealth requirements. You will still have to use these modifiers when you report telehealth services.