Code changes for all medical specialties take effect on January 1, 2018 as a result of the CPT Editorial Panel process. The American Medical Association (AMA) is responsible for Current Procedural Terminology (CPT) and has convened the CPT Editorial Panel to develop and maintain the nomenclature healthcare providers use to report medical procedures and services. The CPT Editorial Panel meets three times a year to evaluate code change proposals for new and emerging technology and is responsible for reorganizing and maintaining the code set. After codes are created or modified by the CPT Editorial Panel, they go before the Relative Value Update Committee (RUC), also convened by the AMA, to be valued. For more information on the RUC process and how to efficiently complete a RUC survey if you are randomly selected to do so, this 13-minute video prepared by the AMA is a good resource.
The CPT Editorial Panel and the RUC processes are cyclical; code changes approved by the CPT Editorial Panel at the February 2016 meeting, the May 2016 meeting, and the September/October 2016 meeting take effect on January 1, 2018. The Centers for Medicare and Medicaid Services (CMS) takes the RUC recommendations under consideration when assigning final values to codes and updates its payment policies annually via the Physician Fee Schedule rulemaking. The final rule setting code values and payment rates for 2018 was released by CMS on November 2, 2017.
ISASS joined the AMA’s House of Delegates in June 2014. With a seat in the House of Delegates came the opportunity to participate as advisors to the CPT Editorial Panel and the RUC beginning in calendar year 2015. ISASS strives to represent our membership in all three of these forums and provides this educational coding resource to our membership to prepare for spine coding in 2018 and beyond.
Click here for a look at what’s new in spine coding in 2018.
Are you required to report data to CMS by December 31 under the Quality Payment Program’s Merit Based Incentive Payment System (MIPS)? Click here to find out.
The Quality Payment Program (QPP) is the new physician payment system created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and is administered by the Centers for Medicare and Medicaid Services (CMS). Because the QPP is new in 2017, you need to know how to participate. Since 2017 is a transition year, you only need to report at least one quality measure for one patient during 2017 in order to avoid a payment penalty in 2019 under the Merit-based Incentive Payment System (MIPS).
You still have time to report data under MIPS in 2017. A short video developed by the AMA, “One patient, one measure, no penalty: How to avoid a Medicare payment penalty with basic reporting,” offers step-by-step instructions on how to report now so you can avoid a negative 4-percent payment adjustment in 2019. Also on this website, there are links to CMS’ quality measure tools, an example of what a completed 1500 billing form looks like, a link to the CMS MIPS eligibility tool, and other materials. Additionally, the AMA recently released a new customizable resource, the MIPS Action Plan, to help you think strategically about how to successfully participate in MIPS.
On December 11, the U.S. Food and Drug Administration (FDA) Commissioner Scott Gottlieb, MD outlined the FDA’s plans to advance several new regulatory policy initiatives in 2018 to further modernize the Agency’s medical device program and continue to foster new medtech innovation.
Gottlieb described a new, accelerated process to bring certain medical devices to market. In the first quarter of 2018, the FDA plans to publish a draft guidance outlining a voluntary, alternative pathway for demonstrating substantial equivalence of a medical device. Under this new framework, device manufacturers could demonstrate substantial equivalence by meeting objective safety and performance criteria including FDA-recognized standards, FDA-developed guidance documents, or a combination of the two. This new pathway would be available for pre-specified categories of mature devices – those for which safety and performance criteria that meet or exceed the performance of existing, legally-marketed devices can be identified.
Additionally, the FDA plans to issue draft guidance in early 2018 outlining an acceptable level of uncertainty relative to a device’s benefits and potential risks in order to determine the need for pre-market data or post-market data to evaluate such devices.
Click here for a complete list of the FDA’s proposed device guidance development and review for 2018.
CPT codes and descriptions are copyright of the American Medical Association. All Rights Reserved.
The coding opinions referenced do not constitute legal advice. Every effort is made to ensure the accuracy of information provided, however, these opinions do not replace information contained in public or private payer policies or any published CPT material. The final decision for coding any procedure must be made by the surgeon, considering regulations of insurance carriers and any local, state or federal laws that apply to the surgeon’s practice. ISASS nor any of its officers, directors, agents, employees, committee members or other representatives shall have any responsibility or liability for any claim, including but not limited to any claims for costs, legal fees, Medicare or insurance fraud, arising from the use of these opinions.