Part B Insider (Multispecialty) Coding Alert

Published on Sun Nov 26, 2006 PDF

Some imaging codes will lose up to 70 percent of technical component

A total of 150 radiology codes, mostly for imaging services, face steep cuts next year, according to the Centers for Medicare & Medicaid Services. Here's what you need to know to prepare.

CMS plans to increase the discount for multiple imaging scans on contiguous body parts from 25 to 50 percent next year. 

But the agency also plans to reduce the technical component of many codes in line with the Hospital Outpatient Prospective Payment System (HOPPS) levels, in the 2007 physician Fee Schedule .

At the March Practicing Physicians' Advisory Council meeting, CMS officials presented data showing that approximately 150 out of 600 radiology services had higher technical rates in the doctor's office than in the hospital outpatient department. This justifies the 50-percent "multiple imaging" discount as well as the HOPPS-related cut, according to CMS officials.

High-Volume Practices Beware

Every managed care plan that can imitate these imaging cuts probably will, warns Thomas Powell, a senior consultant with Healthcare Administrative Partners in Media, PA. If your practice is doing high volumes of certain procedures, you could be in trouble, he adds.

The impact: The reductions to HOPPS levels will slash ultrasound guidance procedures between 40 and 70 percent, depending on the code. Most other ultrasound codes won't be affected, Powell says. But Doppler echo code 93321 will sink 24 percent.

The HOPPS reductions will slash MRIs an average of 35 percent, and some codes will drop as much as 50 percent, Powell predicts. CT scans will be reduced 9.44 percent on average, with some codes dropping as much as 20 percent and others not at all. Most nuclear scans won't be affected, except for cardiac nuclear scans, which will drop between 10 and 20 percent.

Meanwhile, the 50-percent imaging reduction for contiguous body parts will cause your technical component income to drop between 2 and 10 percent, depending on how often your doctor performs multiple scans, Powell says.

Note: For more tips to prepare for cuts, see "Know Your Imaging Costs Now, Or Pay The Price Next Year" later in this issue.