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Otolaryngology Coding Alert

Celebrate Congress' Relief of Planned Pay Cut

2007 fee schedule still raises cognitive services- work RVUs The 2007 Medicare Physician Fee Schedule's increased values for 99213 may not provide your bottom line with a substantial boost, but at least you won't see that bottom line shrink due to the previously scheduled payment cuts. 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 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 to cut the CF across the board.

The numbers: To keep the reimbursement rate the same, Congress passed a freeze on Dec. 9 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. 2. Calculate Fees With Transitional RVUs A freeze, however, does not mean CPT 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 CPT 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. Expect Cognitive Work Hike Despite Objections

Higher RVUs for some E/M services make a difference for some ENTs, but the hike won't matter much, says Andrew Borden, CCS-P, CPC, reimbursement manager in the department of otolaryngology and communication sciences at the Medical College of Wisconsin in Milwaukee. -The majority of our income is from surgical and procedural coding.-

Example: CMS assigned an additional 0.25 work RVUs to 99213 (Office or other outpatient visit for the evaluation and management of an established patient ...). That increase, plus a slight PE raise, will result in more than an additional $9-10 for level-three visits as noted below:
*Note: 2007 values, except work, listed in this article are all transitional and use the 2006 CF of 37.8975. The American Academy of Otolaryngology -- Head and Neck Surgeons (AAO-HNS) [...]

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