Pediatric Coding Alert

Plus: CMS could allow chiropractors to bill E/M codes next year.

CMS offers several bits of good news in its recently-finalized 2014 Medicare Physician Fee Schedule, including the fact that the agency didn’t slash pediatric pay as it did to some other specialties--but the agency also included a 20.1 percent conversion factor cut that could impact practices across-the-board if Congress doesn’t act to reverse it before Jan. 1.

On Dec. 10, CMS published its Final Medicare Physician Fee Schedule for 2014. The 1,369-page document is applicable to your pediatric practice because most private payers base their fees on Medicare reimbursement amounts.

Make Congressional Intervention Your New Year’s Wish

CMS notes in the Final Rule that the confirmed conversion factor is $27.2006, which is a 20.1 percent cut from the current rate of $34.0230. Although this is better news than the $26.7109 that CMS had predicted for 2014 in the proposed rule, it’s still quite dismal, and most practices would not be able to stay in business if they lost 20 percent of their income. Therefore, as in prior years, practices will have to keep their fingers crossed that Congress votes to increase the conversion factor before Jan. 1 so that physicians don’t face such severe cuts.

Physician advocacy organizations are understandably tired of the annual waiting game for Congress to fix the conversion factor. The American Medical Association urged Congress to repeal the current sustainable growth rate formula as soon as possible so this problem can be rectified.

“The AMA has heard the nation’s physicians and we’re pulling out the stops to get Congress to act and take a fiscally responsible course that will stop the annual cycle of draconian Medicare cuts and short-term patches,” said AMA President Ardis Dee Hoven, MD at the AMA’s Nov. 18 meeting. “Now is the time to move past the annual SGR crisis and toward a Medicare program that ensures access to high-quality and efficient health care for patients and a stable practice environment for physicians.”

Pediatricians Won’t Face Steeper Cuts

The 20.1 percent cut in the conversion factor will unfortunately not be the only pay cut that the finalized Fee Schedule holds for some specialties, as diagnostic testing facilities will face a startling 11 percent cut. CMS points out that this is “estimated prior to the application of the negative 2014 on version factor update.” In other words, these facilities will face the 20.1 percent overall cut in addition to an 11 percent reduction in pay.

Pediatricians, however, will see some stability, with your specialty not gaining or losing—the difference in pediatric pay between 2013 and 2014 is listed as “zero percent” in the Fee Schedule

As for specific procedures that will take big hits in 2014, you’ll see a 34 percent pay cut when performing destruction of premalignant lesions (17000), a 33 percent cut for complete electrograms (93000), a 27 percent cut for level three office visits (99203 and 99213), and a 26 percent cut for 99214. You can find the full list of slashed payments starting on page 1,289 of the CMS Final Rule.

Could You Be Competing With Chiropractors in 2015?

Although you might currently see family practitioners and nurse practitioners as your biggest competition in the primary care arena, that could change. One feature of the 2014 Fee Schedule that may have caught your eye suggests that CMS is evaluating whether chiropractors should be able to provide and bill for E/M services.

Some patients do look to their chiropractor as a primary care physician and complain about many other ailments besides subluxations, so chiropractors are sure to be welcoming this news. Pediatricians may not feel the same way, but nothing is set in stone yet, and no decisions will be made for a while.

“We are not proposing to pay chiropractors for E/M services in CY 2014,” CMS notes in the 2014 Fee Schedule. However, if after analyzing public comment, the agency believes it’s a good idea, the issues “will be addressed in future notice and comment rulemaking.”

To read CMS’s final 2014 Physician Fee Schedule rule, visit www.ofr.gov/(X(1)S(p1ydjssklek03usvybyvckft))/OFRUpload/OFRData/2013-28696_PI.pdf.