Pulmonology Coding Alert

Watch out: 2007 fee schedule cuts $750 from 31730 to prevent double-billing
 
You'll receive a welcome hike to your frequently billed high-level office visit, hospital and critical care codes. The 2007 Medicare Physician Fee Schedule will deliver anywhere from almost an additional $10 to more than $18 for 99291. 1. Applaud Probable Rate Freeze Congress heard your cries and froze the payment cut for 2007. "There was an outcry from numerous physicians and physician associations to the planned 5.1 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, Congress approved a freeze on Dec. 9 that if passed will keep the CF at the current 2006 rate of 37.8975 instead of decreasing it to the scheduled 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.

If the scheduled CF reduction occurs, you would have still benefited from a slight overall gain in 2007. Averting the pay cut will mean the increase in payment to pulmonologists next year will be around 6 percent, not 1 percent, says Alan L. Plummer, MD, professor of medicine, Division of Pulmonary, Allergy, and Critical Care at Emory University School of Medicine in Atlanta. 2. Calculate Fees With Transitional RVUs 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).

Do this: When determining a code's payment rate, make sure to choose the total RVU that represents the current year. "The transitional columns [P and R] indicate the current values that apply," Still says. To get a long-range look at what you can expect those values to ultimately become, look to the code's fully implemented total RVUs (columns Q and S), which will become effective in 2010. 3. Cheer for Gain From Review Pulmonary medicine emerges from the five-year work and PE review with more RVUs -- and will continue to experience increases. You can expect 6 percent more work RVUs in 2007 than in 2006. You'll receive an initial boost of 1 percent to your PE RVUs. Those values will go up an additional 1 percent by 2010. Your grand combined work and PE RVU total [...]