Neurosurgery Coding Alert

Due to congressional mandates to lower overall Medicare spending, the national average 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, which applies to all Medicare claims after Jan. 1, 2002, was announced by CMS in the Nov. 1, 2001, Federal Register and represents the first decrease in the conversion factor in 10 years. The lower conversion factor for 2002 means that all physicians can expect an overall decrease in Medicare payments.
 
When multiplied by the number of relative value units (RVUs) assigned to a CPT code, the conversion factor determines the national average Medicare payments for each CPT code. For instance, 61304 (Craniectomy or craniotomy, exploratory; supratentorial) has been assigned 39.14 RVUs for 2002. To determine the average national Medicare payment for this procedure, the RVUs (39.14) are multiplied by the conversion factor ($36.1992) for a total payment of about $1,417.
 
Payments vary according to geographic region as determined by the local cost of the individual components (work, practice expense and malpractice expense RVUs that make up the overall value assigned to each CPT code. Exact payment for a code in a given area is determined by using the 2002 Geographic Practice Cost Indices (GPCI), which was also published in the Nov. 1 Federal Register.