Part B Insider (Multispecialty) Coding Alert
RVUs In For Big Changes--Will You Win Or Lose?
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Now's the time to speak up about drastic PE-RVU changes
Some CPT codes could see double-digit cuts next year, if the Centers for Medicare & Medicaid Services has its way.
CMS wants to change the way it calculates practice-expense relative value units (PE-RVUs), on a "bottom up" instead of "top down" basis. At a Feb. 15 town hall meeting, CMS officials unveiled four different methods for calculating PE-RVUs--and a list of winners and losers.
Audiologists would lose between 15 and 22 percent of their total allowed Medicare charges. Hematologists/oncologists, cardiologists and nuclear medicine physicians also stand to lose out. Meanwhile, dermatologists could gain between 14 and 20 percent of their payments, and gastroenterologists and oral surgeons could also win big.
CMS hadn't done a good job, up till now, of explaining its new methods for figuring out your expenses, complains a spokesperson for the American College of Surgeons. The explanation at the town hall meeting was more complete, but there are still inconsistencies which may be the result of programming errors, the ACS source says.
Contact your association: Physician specialty societies are just figuring out how this new data will affect you, according to a spokesperson for the American Society for Clinical Oncology. You still have a chance to make your voice heard.
Watch out: CMS also released a table showing how the changes could affect some big-ticket codes.
Examples: 3-D heart imaging code 78465 currently has 12.34 PE-RVUs, but under the proposed new formulas it would have between 8.18 and 9.26 PE-RVUs. Radiation treatment delivery code 77418 would drop from 18.07 PE-RVUs to between 9.12 and 13.08 PE-RVUs. Left-heart cathterization code 93510 has 39.24 PE-RVUs, but it would drop to between 20.24 and 21.14 PE-RVUs if CMS changes the formula.
But intracoronary stent insertion code 92980 now has 6.07 PE-RVUs, and it would have 10.47 to 12.21 PE-RVUs next year, depending on which formula CMS uses.
Note: To obtain the complete chart of proposed PE-RVUs for major codes, email charlie@partbinsider.com with "chart" in the subject line.
Part B Insider (Multispecialty) Coding Alert
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