Neurology & Pain Management Coding Alert

Check for changes in the 2009 fee schedule in 2 places. Figuring out where the 1.1 percent increase is on your 2009 conversion factor of 36.0666, compared to the current 38.0879, can feel daunting, but clarification is on the way. How much Medicare pays per relative value unit (RVU) comes from many areas, explained CMS's Amy Bassano, in "Medicare Physician Payment Schedule 2009 Changes and Beyond" at the CPT and RBRVS 2009 Annual Symposium in Chicago. While a 1.1 percent update to the physician fee schedule was required by the Medicare Improvement for Patients and Providers Act (MIPPA) of 2008, the transition application of budget neutrality for the third of five-year review also came into play."The AMA really fought for the 1.1 percent increase," confirmed Sherry L. Smith, MS, CPA, director of physician payment policy and systems for the AMA during the same session. This will really benefit physicians. Rather than applying the transitioned budget neutrality adjustment (BNA) to the work RVU as in 2008, the BNA will be applied to the conversion factor for 2009. The change was also championed by the AMA and many specialty societies. Where's the change? The percent change comes in the work practice expense (PE) portion of a code's RVUs. Codes comprised mainly of work PE will get a boost. Those codes with RVUs based mainly on high equipment/practice expense, such as diagnostic services, rather than work, however, may decrease in pay, Smith said.  Even though it may appear that the conversion factor is decreased for 2009, due to the application of the BNA, some codes will see even more than a 1 percent increase. For instance, 99213 (Office or other outpatient visit for the evaluation and  management of an established patient, which requires at least 2 of these 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity ...) will see an increase of 2.5 percent, from a national Medicare 2008 allowable of $59.80 to $61.31 in an office site of service in 2009.