Neurology & Pain Management Coding Alert

Owing to congressional mandates to decrease Medicare spending, the average national physician payment conversion factor has been lowered from $38.2581 in 2001 to $36.1992 for 2002, a decrease of about 5.5 percent. The new rate applies to Medicare claims after Jan. 1, 2002, and was announced by CMS in the Nov. 1, 2001, Federal Register. It is the first decrease in the conversion factor in 10 years. The lower conversion factor for 2002 means that physicians can expect an overall decrease in Medicare payments, making careful billing and coding more important than ever.
 
When multiplied by the number of relative value units (RVUs) assigned to a CPT code, the conversion factor determines the average national Medicare payments.  For instance, nerve conduction study code 95900 ( amplitude and latency/velocity study, each nerve; motor, without F-wave study) has been assigned 1.18 RVUs for 2002 (.63 RVUs for the professional component only). To determine the average national Medicare payment for this procedure, multiply the RVUs (1.18) by the conversion factor ($36.1992) for a total payment of $42.72 (or $22.81 for the professional component alone).
 
Payments vary by geographic region as determined by the local cost of the individual components (work, practice expense and malpractice expense RVUs: See Physician Fee Schedule Affects Coding Efficiency, this issue, for more information) that make up the overall value assigned to each code. Exact payment for a code in your area may be determined by using the 2002 Geo-graphic Practice Cost Indices (GPCI), which was also published in the Nov. 1 Federal Register.