Pediatric Coding Alert

Congress votes to avert CF payment cut and maintain 2006 rate Your payment picture for 2007 just got rosier. Congress heard your cries and froze the payment cut for 2007.

"There was an outcry from numerous physicians and physician associations to the planned 5 percent cut to the conversion factor (CF)," says Russ Still, executive vice president of Medical Management Associates in Atlanta. To increase values for cognitive services like 99213 and 99214 while maintaining mandated budget neutrality, CMS had planned on cutting the CF across the board.

The numbers: To keep the reimbursement rate the same, on Dec. 9 Congress passed a freeze that if enacted will keep the CF at the current 2006 rate of 37.8975 instead of decreasing it to the proposed 2007 rate of 35.9848. "President Bush is expected to sign the measure in the next week," says Robert B. Doherty, senior vice president of governmental affairs and public policy for the American College of Physicians. Expect About 2 Percent More Than in 2006 A freeze, however, does not mean code payments will remain the same in 2007. Because of the five-year review, the CF tells only part of the story, Still says. To calculate a code's payment, you also need to look at any changes to the code's work and practice expense (PE) relative value units (RVUs).

An analysis of 20 commonly billed pediatric codes shows that if the CF freeze goes into effect, each code would increase on average about 2 percent over 2006 rates, says Karen Walker, administrator at Pediatric Services of Florida in St. Petersburg. For instance, "pediatricians will see an approximate $1.50 increase in initial immunization administration codes (90465, 90471), provided those administration codes have not been flat-rated in their payer contracts," she says.

Another example: If the scheduled 2007 CF cut takes effect, 99213 would go up about $7 (as reported in the January 2007 Pediatric Coding Alert). The probable rate freeze means 99213 would increase an additional $3.18 to $62.91 from the planned rate of $59.73. The adjusted payment rates for 99213 and other codes included in the article are:

Note: For an updated version of the January 2007 Pediatric Coding Alert article "Look Forward to a Bigger Piece  of the Payment Pie for Acute E/M Services" and the table containing frequently used pediatric codes, e-mail the editor at jgodreau@medville.com with the subject line "fee schedule." The documents contain pertinent numerical adjustments due to the proposed legislative freeze to the 2007 conversion factor.