Are reimbursement changes cause for alarm?

Critical care physicians are protesting the proposed changes in Medicare reimbursement rules that would restrict payments for some emergency patients.

The debate centers on the application of critical care physician reimbursement codes - specifically codes 99291 and 99292 - to a smaller group of patients. The Society for Critical Care Medicine (SCCM) says two Medicare carriers, in Texas and the Washington, DC, area, have announced amended versions of the codes and are seeking public comment.

At issue are the use of the terms "constant attention" and "constant attendance," and a proposal that postoperative services be provided only by the operating surgeon.

The SCCM is also cautioning critical care providers to be aware of the approaching implementation of Medicare documentation guidelines for evaluation and management services, now scheduled for July 1. While critical care physician reimbursement codes 99291 and 99291 are not affected, other hospital consultation codes used by critical care physicians are affected by the new guidelines.

"Compliance with the . . . documentation guidelines present an onerous and burdensome challenge for all physicians," said George Karras, MD, chairman of the SCCM reimbursement and managed care committee. He said quality of care will suffer if critical care physicians have to take time away from patient care to comply with these "overly restrictive and misguided regulations."