Orthopedic Coding Alert

If this proposal sticks, 2018 reimbursement rate won’t rise much.

The Centers for Medicare and Medicaid Services (CMS) has released its proposed fee schedule conversion rate for 2018, and the numbers haven’t shifted much from last year.

The lowdown: CMS is proposing a conversion rate of 35.9903 per relative value unit (RVU). This conversion rate would be a slight increase from the 2017 conversion rate of 35.8887.

This proposed conversion rate “reflects a budget neutrality adjustment of minus-0.03 percent, a misvalued code recapture amount of minus-.019 percent, and the 0.5 percent update factor specified under MACRA [Medicare Access and CHIP Reauthorization Act],” explains Mary I. Falbo, MBA, CPC, president & CEO of Millennium Healthcare Consulting, Inc. in Lansdale, Pennsylvania.

Fee Schedule Won’t Make Huge Bottom Line Difference

In case you are wondering, this conversion rate change wouldn’t make much difference when paying out for codes. The proposed jump to 35.9903 “is just a minor increase, so for most practices they will hardly feel the change,” explains Melanie Witt, RN, CPC, MA, an independent coding expert based in Guadalupita, New Mexico.

Example: Evaluation and management (E/M) code 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 …) currently holds a relative value unit (RVU) of 2.06 in the office setting; at this rate, Medicare would reimburse for 99213 at $73.93.

When the conversion factor increases to 35.9903 (assuming the RVUs for 99213 do not change), the same service will be worth $74.14 in 2018, Witt explains.

Want to Comment? Get in Before This Date

Providers wishing to be heard on the proposed 2018 conversion rate should get their comments in line soon.

“CMS will accept comments on the proposed rule until September 11, 2017, and will respond to comments in a final rule on or about November 1, 2017,” according to a CMS press release.

Expert’s final take: “The final fee schedule goes into effect January 1, 2018, and it is rare that the conversion factor changes between the proposed rule and the final rule,” according to Witt.