Urology Coding Alert

Caution: Expect reduction in your E/M code reimbursement as well If the proposed 2008 physician fee schedule that CMS released in July goes through as planned, the reimbursement for services your urologist provides to Medicare patients will face a 9.9 percent cut next year.
Be Cautiously Hopeful Congress Will Act There is some hope: Congress may step in to save you from such a steep cut just as it has done for the past few years. Congress acted at the very last minute to prevent a steep cut to your reimbursement in January 2007 by approving and passing a freeze that kept the conversion factor (CF) at the current 2006 rate of 37.8975 instead of decreasing it to the scheduled 2007 rate of 35.9848. No one can guess yet whether Congress will step in again for next year, experts say. "However, even if Congress steps forward and reduces the 9.9 percent cut, there are other subtle areas that will be cut regardless of Congress," says Gail Lorenzen, CHBC, senior consultant with The Sage Group in Phoenix. Example: The budget neutrality work adjustor will be reduced to 0.8816 from 0.8994 next year. This means your physician's work payments will drop another 2 percent in 2008, mainly affecting your E/M reimbursement, says Lorenzen. One of the most frequently billed services, 99213 (Office or other outpatient visit for the evaluation and management of an established patient ...), will be reduced from $59.50 to $58.73 based on the unadjusted Medicare fee schedule. "A practice's payments are calculated from a formula based on three components: physician work, practice expense, and malpractice, all adjusted for geographic variations," Lorenzen says. "Changes to any of these elements impact your payments." In addition: Your geographic price cost index (GPCI) may change and mean further cuts in your 2008 payments. Your payments are set to face an additional drop if you live in 56 of 89 payment localities where the work GPCI is typically less than 1.0, CMS said in the proposed fee schedule. Of note is that the provision passed by Congress to set a minimum 1.0 GPCI nationwide for work relative value units (RVUs) expires at the end of 2007. If you're in North Dakota or Montana, for example, your work GPCI would fall by about 3 percent due to removal of the work GPCI floor of 1.0 and further compacted by proposed geographic adjustment factor (GAF) revisions that would create an additional 0.82 percent and 0.45 percent decrease.
Bulk-Discount Elimination Means More Money The bright side: CMS decided to accept a number of recommendations from the AMA's Relative Value Update Committee (RUC) that it ignored last year. More money: CMS will adjust the work RVUs for more [...]