ED Coding and Reimbursement Alert

In the Nov. 1, 2000, Federal Register final rule for revisions to payment policies under the 2001 Physician Fee Schedule, HCFA has introduced a 4.5 percent overall increase in payments to physicians for Medicare Part B services.

The 2001 fee schedule conversion factor has increased to $38.2581. The separate 2001 national average anesthesia conversion factor is $17.26.

The final rule lists individual relative value units (RVUs) for each individual CPT and HCPCS code, and outlines estimated changes in payment rate by specialty. Some specialties, such as optometry, will realize increases of 12 percent, while others, such as gastroenterology, will see no change in the estimated payment rate.

According to HCFAs estimated change from 2000 to 2001 in payment rates by specialty, emergency medicine physicians will receive a 2 percent rise in 2001.

Under the new fee schedule, physicians can receive separate payment for certifying and recertifying that patients are eligible for Medicare home health services. Previously, these services were included in the physicians evaluation and management (E/M) codes. HCFA now states that it plans to introduce new HCPCS codes for certification and recertification of home health services to emphasize the importance of physician involvement in home health services under the new home health PPS system.

HCFA has reassigned the RVU for deleted code G0169 (removal of devitalized tissue, without use of anesthesia [conscious sedation, local, regional, general]), a temporary wound care management code, to the new wound care codes 97601 (removal of devitalized tissue from wound; selective debridement, without anesthesia [e.g., high pressure waterjet, sharp selective debridement with scissors, scalpel and tweezers], including topical applications, wound assessment, and instructions for ongoing care, per session) and 97602 (non-selective debridement, without anesthesia [e.g. wet-to-moist dressings, enzymatic, abrasion], including topical applications, wound assessment, and instruction[s] for ongoing care, per session). The RVU for these codes remains 0.50.

HCFA also has introduced the new HCPCS code G0168 (wound closure utilizing tissue adhesives only) for the use of wound repair using Dermabond. This service will carry no global period.

The full, 800-plus page final rule can be downloaded from the Federal Register by visiting http://www.access.gpo.gov From there click on Quick Links go to the Federal Register, use the Browse Feature and access the Federal Register Table of Contents and click on 2000. View the final rule under November 1 and scroll down to the section on Health Care Financing Administration for the 2001 fee schedule.