Gastroenterology Coding Alert

Get ready for another year of nail-biting to find out if Medicare payments will be cut.

"The update to the physician fee schedule conversion factor is -21.2 percent for CY 2010," notes the 2010 Medicare Physician fee schedule Final Rule, printed in the Federal Register that will be published on Nov. 25.

Traditionally, Congress has stepped in to reverse such dramatic cuts before they take place, but unless that happens this year, you'll face a conversion factor of $28.4061 effective Jan. 1, according to calculations in the Federal Register.

Gastroenterologists do dodge one bullet: Although cuts to certain CPT codes will have a drastic impact on certain specialties in 2010, the Centers for Medicare & Medicaid Services (CMS) estimates that gastroenterology practices will see reimbursement drop by only 1 percent next year.

In contrast, nuclear medicine specialists will see their reimbursement drop by 18 percent in 2010, and by 23 percent over a four-year period. Cardiologists will be watching their payments drop by 8 percent in 2010, and by 13 percent over the next four years.

Good news: Although CMS has proposed halting payment for the consultation codes (99241-99255) in 2010 (see "CMS Proposes Elimination of Consultation Pay on Jan. 1" in Gastroenterology Coding Alert Vol. 11, No. 10), the American Medical Association (AMA) chose not to delete them, keeping them in the CPT manual for another year.

Bad news: "Beginning January 1, 2010, we will eliminate the use of all consultation codes (inpatient and office/outpatient codes for various places of service except for telehealth consultation G codes) on a budget neutral basis by increasing the work RVUs for new and established office visits" and for initial hospital and initial nursing facility visits, according to the 2010 Medicare Physician Fee Schedule Final Rule.

The elimination of consult codes will hurt specialty practices in particular, says Susan Vogelberger, CPC, CPC-H, CPC-I, CMBS, CCP-P, CEO of Healthcare Consulting and Coding Education in Boardman, Ohio.

CMS will raise payment for the other E/M codes to try and offset the consult loss. For instance, you'll see a 7 percent increase for 99214, with physician work relative value units (RVUs) rising to 1.50 from the 2009 rate of 1.42. However, certain specialists still end up losing money.

Smart step: Your non-Medicare payers may still accept 99241-99255. You may want to check with your third-party payers for guidance, suggests Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Atlanta.

Keep reading Gastroenterology Coding Alert for more updates on CPT codes -- and how your payments might be affected next year -- as they become available.

For more information on Medicare's physician reimbursement plans for next year, read "Payment Policies Under the Physician fee schedule and Other Revisions to Part B for CY 2010" at www.federalregister.gov/OFRUpload/OFRData/2009-26502_PI.pdf.