Coding, Billing, and Reimbursement
As a chest medicine specialist, it’s important that you stay current on the latest developments in clinical practice and operations. With this, CHEST and the American Thoracic Society (ATS) have partnered to form a Joint Clinical Practice Committee. The mission of this group is to monitor, review, comment on, and educate the membership of both societies on coding, billing, and regulatory compliance issues that impact pulmonary, critical care, and sleep medicine. This group actively participates in the American Medical Association (AMA) RUC and CPT processes and monitors, reviews, and comments on Centers for Medicare & Medicaid Services (CMS) coverage and payment policy, as well as advocates with CMS staff for pulmonary, critical care, and sleep services.
Below, you will find resources to assist you with your practice.
Joint CHEST/ATS Coding Webinar on Medicare 2025 Final Rule
Recorded: January 29, 2025
Coding and billing experts from the Joint CHEST/ATS Clinical Practice Committee explain changes in the Medicare 2025 Physician Fee Schedule Final Rule that will impact pulmonary and critical care medicine providers.
WATCH THE WEBINAR »
Comment and sign-on letters
Joint ATS/CHEST Comment Letter on CY 2025 MPFS Proposed Rule
September 9, 2024 | CHEST and the American Thoracic Society sent comments on the 2025 conversion factor, CMS time policy on critical care services (CPT code 99292), disposable supplies (bronchscopes and home sleep testing devices), depression screening, surgical global period, telehealth services, lung cancer screening improvement activities, and primary care.
Joint CHEST/ATS ICD-10 Comment Letter
October 12, 2023 | CHEST and the American Thoracic Society sent comments on coding proposals to be considered at the ICD-10 Coordination and Maintenance Committee meeting. The comments addressed the assignment of unique diagnostic codes for both cement and fat pulmonary emboli, as distinct from other forms of emboli (eg, thrombotic or air emboli), among other code updates.
Reflecting PCCM concerns in CMS reimbursement plan
September 28, 2023 | In a formal letter to the Centers for Medicare & Medicaid Services, CHEST and the American Thoracic Society provided comments on the Calendar Year 2024 Medicare Physician Fee Schedule proposed rule. The recommendations serve to reflect the needs of Medicare beneficiaries with various disorders of the lung.
Comments on CY 2024 Medicare HOPPS and ASC Payment System Proposed Rule
September 11, 2023 | CHEST and the American Thoracic Society submitted shared comments on the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) Payment System Proposed Rule for Calendar Year 2024.
Comments to CMS on SEP-1 in FY2024 IPPS/LTCH PPS Proposed Rule
June 9, 2023 | CHEST sent comments to the Centers for Medicare and Medicaid Services expressing strong support regarding the adoption of the Severe Sepsis and Septic Shock Early Management Bundle – commonly known as “SEP-1” – into CMS's hospital value-based purchasing program, as was recommended in the FY2024 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Proposed Rule.
ATS/CHEST Comments on ICD-10 Prone Positioning Codes
April 24, 2023 | CHEST and the American Thoracic Society expressed gratitude for the inclusion of the new ICD-10-PCS codes capturing prone positioning of intubated patients in the FY2024 Proposed Rule documents.
ATS/CHEST Comments on ICD-10 Coding Proposals
April 5, 2023 | CHEST and the American Thoracic Society provided feedback on coding proposals that were considered at the March 2023 ICD-10 Coordination and Maintenance Committee meeting. The proposals covered insufficient social insurance and welfare support, participation in the Persian Gulf theater of war, classification of obesity, post-exertional malaise/post-exertional symptom exacerbation, sepsis aftercare, and genetic disorders.
Joint ATS/CHEST Comments to CMS on ICD-10 Codes
October 14, 2022 | CHEST and the American Thoracic Society sent comments to the Centers for Medicare & Medicaid Services on coding proposals to be considered at the March 2023 ICD-10 Coordination and Maintenance Committee meeting, including proposals related to intubated prone positioning, bronchiolitis obliterans syndrome, and social determinants of health.
AMA Sign-on Letter Regarding Medicare Physician Payments
September 22, 2022 | CHEST signed onto a letter from the American Medical Association and dozens of other medical societies expressing concerns about the mounting financial instability of the Medicare physician payment system.
Letter to CMS on CY 2023 HOPPS
September 12, 2022 | CHEST joined the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Association for Respiratory Care, and the American Thoracic Society to comment on payment changes to pulmonary rehabilitation programs.
ATS/CHEST Comments to CMS on Proposed Medicare Physician Fee Schedule for 2023
September 6, 2022 | CHEST and the American Thoracic Society submitted shared comments on several aspects of the proposed Medicare Physician Fee Schedule for 2023, including rate setting and the Medicare conversion factor, practice expense data collection, evaluation and management (E/M) visits, and more.
Letter to CMS on CY 2023 Physician Fee Schedule
August 24, 2022 | CHEST joined several pulmonary organizations and patient advocacy groups to comment on the safety and effectiveness of direct supervision through virtual presence as it relates to cardiac and pulmonary rehabilitation programs.
ICD-10 Code for Prone Positioning
June 10, 2022 | CHEST and ATS submitted a proposal to capture the services involved in prone positioning of intubated patients. The societies expect that creating this new code will allow better tracking of prone positioning use, as well as help institutions better understand the resources used in providing prone positioning services.
ICD-10 Code for Sepsis Aftercare
June 7, 2022 | CHEST, along with other members of the Critical Care Societies Collaborative, sent a letter strongly supporting a proposal for a new ICD-10-CM code, "Z51.2 – Encounter for Sepsis Aftercare." The societies noted that this code will improve public health by identifying a growing population of sepsis survivors and facilitating provision of relevant clinical services to reduce the well-known, health-related risks in postacute care settings.
Joint CHEST/ATS Comments to CMS on Proposed 2021 Medicare Physician Fee Schedule
October 5, 2020 | CHEST and ATS submitted comments to help CMS craft the final 2021 Medicare Physician Fee Schedule rule.
Additional resources
For more information related to clinical practice resources or the Joint Clinical Practice Committee, please contact Suzanne Sletto, ssletto@chestnet.org.