Is your urology practice prepared for evaluation/management coding changes in 2021?

November 2, 2020
Karen Nash

Karen Nash is a medical reporter and media consultant based in Monroeville, PA.

Urology Times Journal, Vol 48 No 11, Volume 48, Issue 11

“It’s going to be a slow process for hospitals to give the proper information to their physicians so that when we’re moving on to the new coding system, we’re not doing extra work," says one urologist.

Urology Times® reached out to 3 urologists (selected randomly) and asked them each the following question: Is your urology practice prepared for evaluation/management coding changes in 2021?

"My office manager, who used to be a biller, thinks these changes may simplify billing issues and benefit urology as a specialty overall. I have no experience with how the rules are going to change. I have an electronic medical record [EMR] I trust and that does a fantastic job of generating the right codes for me. We’ve already been alerted to an electronic update coming for the changes.

I don’t know how it will affect surgeries, but from the brief description I have, outpatient visit coding will be maximized. My reimbursement patterns are about 50-50 between surgery and office-based work. So if surgery is affected equally in the negative direction as outpatient is affected in the positive direction, it will probably be a wash for me. Again, it’s just a guess. I rely on my business person and my EMR, which we pay a hefty fee for, to keep these things running well.

We are all naturally skeptical because we are rarely rewarded for an advantage at any time when these changes are made. Urology usually seems to get the short end of the stick. The trend year after year is for a decrease in reimbursement per unit of effort. But this one seems like a potentially reasonable one.”

Victoriano Romero, MD/ Redding, California

“I’m an employed physician in a large company. A team does our coding through a systemwide

EMR, so when codes change, I won’t have access to deleted ones. From that standpoint, there’s not much prep.

I expect it to be ready but don’t know that I’m confident. I’m based on relative value units [RVUs], so whatever the code is, the code is. Am I convinced they’ll be 100% accurate in doing everything? No. But I’m not necessarily worried because I’m RVU based, not cash based.

The higher evaluation/management [E/M] should be helpful for me. I don’t do a lot of big open cases anymore, so I’m not a heavy surgical volume generator of my RVUs. I tend to make more in the office; it shouldn’t be a significant change.

It was different when I operated my own practice because I was responsible for the adjustments. Being employed, that burden falls on somebody else. EMRs have actually made it easier; you can’t put in the wrong codes because they no longer exist.

It’s not like going 10 years without change and suddenly getting one. Come January 1 every year, there’s going to be change somewhere.

With EMRs, as long as coders know a day or 2 ahead of time, they’ll probably be able to make the adjustment because all they have to do at the corporate level is implement an update, which is almost immediate. My understanding is that with the new codes, almost all office visits are going to fall into the same category, so what you have to do to qualify for that code will be more general. It should be a little easier for us.”

Alex M. Horchak, MD/ Dubuque, Iowa

“I’m finding that hospital systems are just as clueless as most private practices are. It’s going to

be a slow process for hospitals to give the proper information to their physicians so that when we’re moving on to the new coding system, we’re not doing extra work.

Fortunately, I’ve been able to educate myself, but I’m finding a lot of my colleagues don’t even know there’s a change coming, and it may be to their benefit, and to their patients’, by reducing the documentation workload. Physicians simply aren’t educated enough on it.

I’m certain it’s not going to be organized by the end of the year, partly because we’re just climbing out of this health crisis and have been focused on surviving that. The E/M changes obviously benefit office-based work, but a lot of doctors, especially those who are procedure heavy, don’t realize that.

Now, I’m director of robotic surgery here, so I’m pretty procedure heavy, but I also have a very busy clinical practice. There will be a drop in my production in terms of surgery and procedures, but I hope my office-based practice will make up for that.

Most hospital-employed physicians probably won’t notice a change for several months, maybe a year. Once administrators realize compensation doesn’t align with the current production, hospital-employed physicians will start feeling it in contract renegotiations. Private practice will need to make adjustments more quickly because they’ll see it on a day-to-day basis. There will definitely be some surprises.

Hospital administrators just don’t know. We’ve had discussions, but nobody realizes this is happening.”

Jaschar Shakuri-Rad, DO/ Morgantown, West Virginia

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