Wiki Nerve Conduction Fee Crosswalk

[aaron.lucas]

Hello all,

Ok, question for anyone who can answer, but first some backstory: I work in NJ for a 3rd party vendor that does admin work for Auto Insurance. We review medical bills related to PIP claims. NJ DOBI (Dept of Banking and Insurance) just released a new Fee Schedule. The fee schedule rule states that any service not on the fee schedule should be paid based on the fee for a similar procedure (or in the case of no similar procedure, by UCR).

Now here is the big issue: The new NCV codes are not in the fee schedule, so according to the regs we have to crosswalk to the old codes. The problem is the old codes all had different fees, and we dont know what combinations these could be billed in to make up a "bundled" fee for these new codes. Basically to figure out the fee for a new code we would need to, on a case by case basis, review and find out what types of studies were done, and then try to add it all up. This could be done, but should we count motors as with or without F-wave, since the new codes dont really take it into account?

Does anybody know, or is anybody familiar with how CMS did their crosswalking of RVUs? Anybody know their methodology? How did others figure this out? I'm struggling to come up with an idea for management and could use some advice. Also if anybody has figured out how to automatically calculate a crosswalked fee based on a programmable formula that would be helpful too! I know this is a lot but any help would be greatly appreciated!

Thanks!

 

[airart]

Neurology Crosswalk for NJ PIP

It can be frustrating figuring out the fee schedules that are not negotiated prior to during credentialing and contracting.

Here in Texas, most PIPs and WCs use 125% of Medicare's Allowable if the CPT code is not listed in a table they use or a managed care network fee schedule (Worker's Comp.)

NJ DOBI uses similar language in their policies too, they go along with Medicare. I dig some digging and found a PDF from AMA that lists the RVUs for some of the new codes. From there you can either convert them manually with the conversion factor or look them up on CMS.gov site by code and carrier, I did an example below of some of the codes found. I used just the National Payment Amount as the carrier. Hope this helps you out.

Here is a link that gives you some of the Work RVUs for the new codes of Neurology for 2013.
http://www.ama-assn.org/resources/doc/cpt/05-neurology-barkley.pdf

EXAMPLE: (I looked up these non-facility national payments for 2013)
H flex codes 95907-95913 (Work RVU's for 2013 per AMA)
95907 1-2 Nerve Conduction Studies Work RVU 1.00 – National Payment Amt $94.58
95908 3-4 Nerve Conduction Studies Work RVU 1.25 – National Payment Amt $116.70
95909 5-6 Nerve Conduction Studies Work RVU 1.50 – National Payment Amt $ 139.83
95910 7-8 Nerve Conduction Studies Work RVU 2.00 – National Payment Amt $ 184.06
95911 9-10 Nerve Conduction Studies Work RVU 2.50 – National Payment Amt $ 222.85
95912 11-12 Nerve Conduction Studies Work RVU 3.00 – National Payment Amt $ 260.96
95913 13 or more Nerve Conduction Studies Work RVU 3.56 – National Payment Amt $ 302.46

For Manual Calculation:

Calculating Payment Amounts
The formula for calculating 2013 physician fee schedule payment amount is as follows:

2013 Non-Facility Pricing Amount =
[(Work RVU * Work GPCI) +
(Transitioned Non-Facility PE RVU * PE GPCI) +
(MP RVU * MP GPCI)] * Conversion Factor (CF)

2013 Facility Pricing Amount =
[(Work RVU * Work GPCI) +
(Transitioned Facility PE RVU * PE GPCI) +
(MP RVU * MP GPCI)] * CF

The MPFS Conversion Factor for CY 2013 is $34.0230.
LINK FOR MEDICARE FEE SCHEDULE HCPCS Lookup:
http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index.html

 

[CBSBOOKKEEPING]

Destruction by neurolytic agent

Patient is having destruction of nerve bilaterally and 3 levels
l3, l4, & l5
in the past i have billed 64635-50, 65636-50 & 64636-5059
is this correct

thank you,
carol f
ny