Medicare Compliance & Reimbursement
Doctors Get Extra Document Postprocessing RVU
Physicians can't count on new CPT codes until Medicare "hatches" relative value units for them. Luckily, physicians' offices are pleased with many of the new reimbursement rates for new CPT codes.
The Centers for Medicare and Medicaid Management Services has released the RVUs for these codes as part of its physician fee schedule final rule, but no one can be sure of the conversion factor yet. Unless Congress takes action, each RVU will be worth 4.4 percent less next year than this year.
Neurology: Many providers had worried that they would lose out on electromyography for needle-placement. Currently doctors can bill 95870 for this service, but next year they should use 95873 (for electrical stimulation) or 95874 (for needle EMG). Providers had worried 95873-95874 would pay less than 95870, but in fact they reimburse the same amount, around 0.78 non-facility RVUs.
This is great news, although the RVUs for a new code frequently change after the first year or two, notes Marvel Hammer, president of MJH Consulting in Denver. She's surprised to see that the reimbursement levels for E-stim and needle EMG are the same, given the expense of an EMG machine.
Radiology: Physicians won't lose out if they perform 3-D reconstructions in the non-facility setting. This year, physicians bill 76375 for 3-D or holographic reconstructions, and receive 3.94 RVUs. But CPT 2006 deletes 76375 and replaces it with two codes: 76376 (3-D reconstruction without postprocessing) and 76377 (...with postprocessing). Physicians can't use either of these codes for non-3-D reconstructions.
When a doctors uses postprocessing, she can receive 4.88 RVUs, nearly a whole RVU more than last year. But if she doesn't use postprocessing, then her payments drop slightly to 3.80 RVUs.
Good news: This is a nice boost to providers that routinely do postprocessing, says Jeff Fulkerson with Emory Healthcare in Atlanta. It's important to document that postprocessing happened on a separate station and what the images showed.
Also, physicians can receive 3.44 RVUs for performing a central venous access device assessment (36598).
Vascular surgery: Another boost: new mechanical venous thrombectomy codes 37184 and 37187 pay 12.57 RVUs and 11.69 RVUs respectively. This is a lot more than existing mechanical thrombectomy code 36870, which only pays 8.60 RVUs. Fulkerson speculates that the new codes cover more complex operations than a simple AV fistula, such as the femoral artery. And a physician can gain an extra 4.60 to 8.45 RVUs by billing new add-on codes 37185, 37186 for additional vessels and 37188 for a repeat treatment.
Medicare Compliance & Reimbursement
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Doctors Get Extra Document Postprocessing RVU
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