สำเนาบทสนทนา 🔗
WEBVTT
00:00:01.360 --> 00:00:05.839
Good morning and welcome to the ACOD Payment in Practice Podcast.
00:00:06.000 --> 00:00:10.560
My name is Lisa Satterfield, and I have some good news for everybody today.
00:00:10.800 --> 00:00:17.039
If you've been following this, you know that we have been working on new maternity care codes.
00:00:17.199 --> 00:00:35.280
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.
00:00:35.520 --> 00:00:40.479
And we were not happy about this because of the confusion and the chaos it was going to cause.
00:00:40.560 --> 00:00:45.200
And it gives the payers the ability to choose which coding system to use.
00:00:45.520 --> 00:00:52.799
Well, I can report to you this morning that CMS decided not to finalize the G-code set.
00:00:52.880 --> 00:00:57.039
So there will not be a parallel coding system moving forward.
00:00:57.759 --> 00:01:09.760
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.
00:01:10.239 --> 00:01:30.959
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.
00:01:31.120 --> 00:01:45.040
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.
00:01:45.200 --> 00:01:47.519
But that's the only circumstance that that can happen.
00:01:47.599 --> 00:01:57.439
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.
00:01:57.599 --> 00:02:02.560
And again, this is important to understand that this is a health plan decision.
00:02:02.799 --> 00:02:08.479
So it can be different determining depending on the uh health plan.
00:02:09.280 --> 00:02:19.039
But um other than that, we were really excited about the decision that CMS made to continue with this new coding system.
00:02:19.120 --> 00:02:20.479
So we're very happy.
00:02:20.639 --> 00:02:33.039
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.
00:02:33.120 --> 00:02:35.599
So just your advocacy made a difference.
00:02:35.680 --> 00:02:37.280
And I just want to thank you for that.
00:02:37.520 --> 00:02:42.560
We are monitoring some other things and trying to figure out it's not just the maternity care codes that were in this rule.
00:02:42.639 --> 00:02:44.000
There's a lot of other things.
00:02:44.240 --> 00:02:47.919
For example, um the modifier 25 rule.
00:02:48.000 --> 00:02:58.240
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.
00:02:58.319 --> 00:03:02.719
So we've been fighting this with the AMA and the American College of Surgeons.
00:03:02.960 --> 00:03:06.639
And it was proposed at 50%, it's now at 80%.
00:03:07.360 --> 00:03:17.919
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.
00:03:18.159 --> 00:03:29.120
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.
00:03:29.680 --> 00:03:35.280
Um so, and I know that our colleagues across the House of Medicine are on on board with all this.
00:03:35.360 --> 00:03:45.680
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.
00:03:46.080 --> 00:03:54.800
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.
00:03:55.120 --> 00:04:00.479
I hope this um finds you all well and have a good day.