TRANSKRIPT 🔗
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Good morning and welcome to the ACOD Payment in Practice Podcast.
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My name is Lisa Satterfield, and I have some good news for everybody today.
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If you've been following this, you know that we have been working on new maternity care codes.
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And in July, uh the Centers for Medicare and Medicaid Services proposed a G-code set that maintained the bundled codes while at the same time approving the new maternity codes, proposed new maternity codes.
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And we were not happy about this because of the confusion and the chaos it was going to cause.
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And it gives the payers the ability to choose which coding system to use.
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Well, I can report to you this morning that CMS decided not to finalize the G-code set.
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So there will not be a parallel coding system moving forward.
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So for patients who begin their care in 2027, you will use the new maternity care code set, which includes EM codes for prenatal care.
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Now there is a caveat to all this in that the HHS and CMS are allowing health plans to continue to use the old codes, the 59400, etc., for patients that they started care in 2026.
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So if you had a patient that has their first prenatal visit in October, the health plan is allowed to use the 2026 codes for the care and bill that in 2027.
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But that's the only circumstance that that can happen.
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It's for patients who have existed in the system prior to 2027, so that you can close out their care using the bundled system.
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And again, this is important to understand that this is a health plan decision.
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So it can be different determining depending on the uh health plan.
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But um other than that, we were really excited about the decision that CMS made to continue with this new coding system.
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So we're very happy.
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And just I personally want to thank all of you who engaged in the advocacy because it was noted in the in the final rule that uh thousands of people were against the G codes.
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So just your advocacy made a difference.
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And I just want to thank you for that.
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We are monitoring some other things and trying to figure out it's not just the maternity care codes that were in this rule.
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There's a lot of other things.
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For example, um the modifier 25 rule.
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Um, this is something where your payment would be reduced by 50% if you um performed um an EM service with another service on the same day.
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So we've been fighting this with the AMA and the American College of Surgeons.
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And it was proposed at 50%, it's now at 80%.
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So while not a full win and still disappointing, um, we will continue to uh work on this with our colleagues across the House of Medicine.
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I do want to say we are very committed to making sure that um physicians are not the ones that are bearing the brunt of the financial woes of a healthcare system gone awry.
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Um so, and I know that our colleagues across the House of Medicine are on on board with all this.
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So still some work to do, but for now, um we will start preparing to help everybody transition into the new code system as we have been.
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And we will um also look forward to working with the health plans to help them transition into the new codes so that it goes smoothly for everyone.
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I hope this um finds you all well and have a good day.