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Research ArticleHEALTH CARE REFORM VIGNETTE
Open Access

Implications of the Revisions and Revaluation of Office/Outpatient Evaluation and Management Codes for Neuroradiology Reimbursement

K.Y. Wang, J.A. Hirsch, G.N. Nicola, L.P. Golding, R.K. Lee and M.M. Chen
American Journal of Neuroradiology June 2020, DOI: https://doi.org/10.3174/ajnr.A6619
K.Y. Wang
aFrom the Department of Radiology (K.Y.W.), Baylor College of Medicine, Houston, Texas
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J.A. Hirsch
bDepartment of Radiology (J.A.H.), Massachusetts General Hospital, Boston, Massachusetts
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G.N. Nicola
cHackensack Radiology Group (G.N.N.), River Edge, New Jersey
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L.P. Golding
dTriad Radiology Associates (L.P.G.), Winston Salem, North Carolina
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R.K. Lee
eDepartment of Radiology (R.K.L.), Einstein Healthcare Network, Sydney Kimmel College at Thomas Jefferson University, Philadelphia, Pennsylvania
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M.M. Chen
fDepartment of Neuroradiology (M.M.C.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas.
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Abstract

SUMMARY: In the 2020 Final Rule, the Center for Medicare & Medicaid Services adopted a new coding structure and accepted the substantial increase in valuation for office/outpatient Evaluation and Management codes set to begin in 2021. Given budget neutrality requirements, the projected increase in reimbursement will require a reduction in the conversion factor to offset such increases. The aim is to inform neuroradiologists the impact of these proposed changes on reimbursement and the profession.

ABBREVIATIONS:

AMA
American Medical Association
ACR
American College of Radiology
CF
conversion factor
CMS
Centers for Medicare & Medicaid Services
COVID-19
coronavirus disease 2019
CPT
Current Procedural Terminology
E/M
evaluation and management
MDM
medical decision-making
MedPAC
Medicare Payment Advisory Commission
MPFS
Medicare Physician Fee Schedule
RUC
AMA/Specialty Society Relative Value Scale Update Committee
RVU
relative value unit

Footnotes

  • Disclosures: Joshua A. Hirsch—UNRELATED: Consultancy: Medtronic, Relievant Medsystems, InNeuroCo, Comments: Medtronic, consultant; Relievant Medsystems, Data Monitoring Committee member; InNeuroCo, consultant; Grants/Grants Pending: Harvey L. Neiman Health Policy Institute. Greg N. Nicola—UNRELATED: Board Membership: Hackensack Meridian Health Partners*; Consultancy: Guidepoint; Stock/Stock Options: Neutigers. *Money paid to the institution.

  • © 2020 by American Journal of Neuroradiology

Indicates open access to non-subscribers at www.ajnr.org

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K.Y. Wang, J.A. Hirsch, G.N. Nicola, L.P. Golding, R.K. Lee, M.M. Chen
Implications of the Revisions and Revaluation of Office/Outpatient Evaluation and Management Codes for Neuroradiology Reimbursement
American Journal of Neuroradiology Jun 2020, DOI: 10.3174/ajnr.A6619

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Implications of the Revisions and Revaluation of Office/Outpatient Evaluation and Management Codes for Neuroradiology Reimbursement
K.Y. Wang, J.A. Hirsch, G.N. Nicola, L.P. Golding, R.K. Lee, M.M. Chen
American Journal of Neuroradiology Jun 2020, DOI: 10.3174/ajnr.A6619
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  • Article
    • Abstract
    • ABBREVIATIONS:
    • HISTORICAL PERSPECTIVE OF OFFICE/OUTPATIENT E/M CODES
    • IMPETUS FOR CHANGE BY THE CMS
    • RESPONSE BY ORGANIZED MEDICINE
    • ADOPTION OF THE 2020 MPFS PROPOSED AND FINAL RULE
    • GLOBAL SURGERY CODES
    • IMPLICATIONS FOR NEURORADIOLOGY
    • MITIGATION AND OPPORTUNITIES
    • Footnotes
    • References
  • Figures & Data
  • Supplemental
  • Info & Metrics
  • Responses
  • References
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    Journal of the American College of Radiology 2023 20 10
  • Declining Medicare Reimbursement for Diagnostic Radiology: A 10-Year Analysis Across 50 Imaging Studies
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    Current Problems in Diagnostic Radiology 2022 51 5
  • Current Reimbursement Landscape of Artificial Intelligence
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    Journal of NeuroInterventional Surgery 2021 13 4
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More in this TOC Section

  • Adding Value to Health Care: Where Radiologists May Contribute
  • Accountable Care Organizations: What Radiologists Should Know
  • The Independent Payment Advisory Board
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