Gastroenterology Coding Alert

Medicare fees for many endoscopic procedures performed in an office setting will increase slightly under the proposed physician fee payment schedule for calendar year 2002. The proposed schedule, which was announced this summer, will complete Medicares four-year transition to a practice-expense-based system from a physician-charge-based system.
 
A colonoscopy with removal via snare technique (45385), for example, will have a nonfacility relative value unit (RVU) of 13.97 versus 13.03 in 2001. The facility RVU, however, will drop slightly to 7.92 from 8.85 in 2001. An esophagoscopic photodynamic therapy with biopsy (43239) will also have an increased nonfacility RVU of 8.32 versus this years 7.48. The facility RVU will drop to 4.14 from 4.59 in 2001.
 
In addition to the fee payment schedule, CMS announced a proposed regulation that would allow nurse practitioners, physician assistants and clinical nurse specialists to be reimbursed for performing screening flexible sigmoidoscopies. The nonphysician practitioners would receive 85 percent of the fee that is paid to physicians for the same screening service. Medicares national policy on colorectal cancer screenings now limit coverage of screening flexible sigmoidoscopies to those performed by either a doctor of medicine or osteopathy. The nonphysician practitioners would still be required to meet Medicare qualification requirements and must be authorized to perform flexible sigmoidoscopies by state law.
 
We estimate that this expansion in the scope of who is allowed to perform screening flexible sigmoidoscopies will increase beneficiary access to these screening services and will result in an increase in the number of covered exams that are performed, stated CMS in the Aug. 2, 2001, edition of the Federal Register.
 
CMS will accept comments on the proposed fee schedule and regulations until Oct. 1, 2001. Final rules for 2002 will be published in the Federal Register in November 2001.