Neurology & Pain Management Coding Alert

On Feb. 28, Medicare published an update to its final rule for the 2003 Physician Fee Schedule in the Federal Register. Although physicians will breath easier knowing that Medicare payments will rise (rather than, as expected, decrease) for 2003, the final rule will complicate billing for procedures provided during the first months of the year. Congress Refactors the Conversion Factor As announced in the Dec. 31, 2002, Federal Register, the conversion factor that determines payment for Medicare services (relative value units as assigned by the Physician Fee Schedule X conversion factor = payment in dollars: Payments are subject to regional cost adjustments) was expected to fall from $36.1992 for 2002 to $34.5920 for 2003, a reduction of about 4.4 percent. The formula CMS uses to determine the conversion factor is set by law and cannot be changed except by congressional action (see March 2003 Neurology Coding Alert for complete details). Fortunately, Congress acted on Feb. 13 to approve the Consolidated Appropriations Resolution 2003, which President Bush signed into law a week later. The Resolution allowed an increase in the conversion factor for 2003, which CMS has now set at $36.7856 ($0.5864 or 1.6 percent higher than the 2002 figure). The new conversion factor becomes effective March 1 and applies to all services provided on or after March 1, 2003. And Now the Bad News The delayed implementation of the 2003 Physician Fee Schedule has created some logistical problems for Medicare payers and physician providers. For example, based on the Dec. 31 final rule and as further explained by CMS Program Memorandum AB-02-181 (Change Request 2486), dated Dec. 23, 2002, CMS will reimburse all services provided during January and February 2003 at the 2002 rate ($36.1992). In addition, payers had to delay all claims containing new-for-2003 codes (available since November 2002) billed prior to implementation of the 2003 fee until March 1 because, under the 2002 fee schedule, there was no way to pay them. For instance, if the physician reported 95990 (Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal [intrathecal, epidural] or brain [intraventricular]), a new-in-2003 code, prior to March 1 the payer could not process the claim because it had no fee schedule available to establish appropriate reimbursement. As of March 1, however, payers should begin to reimburse such claims without delay at the 2003 rate. Note: You may view CMS Memo AB-02-181 at www.cms.gov/manuals/pm_trans/AB02181.pdf. Because of processing delays, not all services provided in January and February will have been settled prior to March 1. For example, the physician might administer a nerve conduction test (95900) on Feb. 28 but does not submit the claim until March 3. The payer, in turn, does not [...]