Part B Insider (Multispecialty) Coding Alert

Published on Thu Sep 15, 2005 PDF

Are you ready for a topsy-turvy new world of expenses?

You soon may have a whole new set of RVU valuations to get used to.

CMS wants to use survey data from specialty societies to set practice expense RVUs, starting next year and phasing in the procedure over four years.

Warning: Some codes will see increases and decreases that have nothing to do with their real costs. For example, CMS predicts that PE-RVUs for 11040 (Debride skin, partial) will increase nearly 20 percent by 2009, but 11043 (Debride tissue/muscle) will fall 7 percent.

Similarly, PE-RVUs for CT of the abdomen (74170) will rise 36 percent, but MRI of the abdomen (74183) will drop by 32 percent, according to figures CMS released. And evaluation and management codes will see their PE-RVUs increase in the office but decrease in the hospital.

And the American Society for Therapeutic Radiation Oncology lists some codes that will see significant decreases in PE-RVUs if CMS goes ahead with its proposal. For example, 77295 (Set radiation therapy field), will go from 27.93 PE-RVUs to 7.26.

Only urologists have good enough data to allow CMS to figure out PE-RVUs based on surveys, claims the American College of Surgeons. Some specialties have named unrealistically high practice expenses, including dermatologists with $212.50 per hour and allergists/immunologists with $233.70 per hour. Other specialties might have to lose money to make up for these high figures, the ACS worries. 

Also, CMS hasn’t explained how its new “bottom-up” methodology for figuring out PE-RVUs for each code will really work, the ACS says. The group asks CMS to hold off on pushing this proposal through for another year to gather better data.