General Surgery Coding Alert

Congress could still act to prevent cuts

You can expect your payments from Medicare to shrink in 2006.

CMS released its 2006 Physician Fee Schedule in early November, and it includes an approximate 4.4 percent reduction in the Medicare conversion factor, which--along with the relative value units (RVUs) assigned to individual codes under the fee schedule--determines payments to Medicare providers.

The magic number: Without congressional action, the conversion for 2006 will equal 36.1171 (down from 37.8975 in 2005).

Dollar-and-cents example: The 2005 fee schedule assigns 4.32 physician work RVUs for 13121 (Repair, complex, scalp, arms, and/or legs; 2.6 to 7.5 cm). In 2005, this would equal payment of $163.72, on average (4.32 RVUs x 37.8975 conversion factor). Assuming no RVU changes for 13121 in 2006, average payment for the procedure would fall to $156.03 (4.32 x 36.1171 conversion factor), or nearly $8 less for the same physician work.

There's hope: Physician advocates hope that Congress, through the budget reconciliation act, will take action to stem the reduction, but lawmakers have yet to tackle the issue.

Keep reading: General Surgery Coding Alert will be the first to alert you if Congress takes action to revise the 2006 conversion factor.