Gastroenterology Coding Alert
Medicare Cuts Conversion Factor 4.4 Percent for 2006
You can expect your payments from Medicare to shrink in 2006.
CMS released its 2006 Physician Fee Schedule in early November, and it includes an approximate 4.4 percent reduction in the Medicare conversion factor, which--along with the relative value units (RVUs) assigned to individual codes under the fee schedule--determines payments to Medicare providers.
The number you-ve been waiting for: Without congressional action, the conversion for 2006 will equal 36.1171 (down from 37.8975 in 2005).
Dollar-and-cents example: The 2005 fee schedule assigns 4.43 physician work RVUs for 45380 (Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple). In 2005, this would equal payment of $167.89, on average (4.43 RVUs x 37.8975 conversion factor). Assuming no RVU changes for CPT 45380 in 2006, average payment for the procedure would fall to $160 (4.43 x 36.1171 conversion factor), or almost $8 less for the same physician work.
There's hope: Physician advocates hope that Congress, through the budget reconciliation act, will act to stem the reduction, but lawmakers have yet to tackle the issue.
Keep reading: Gastroenterology Coding Alert will be the first to alert you if Congress takes action to revise the 2006 conversion factor.
Gastroenterology Coding Alert
- Gastros Gain a Code for Enteryx, but You'll Face New Challenges
Recall means you won't likely access 0133T
CPT 2006 adds 0133T to describe implant injections to [...] - Fill the E/M Gap With Rest Home Service Codes
You'll need 3 of 3 key components to choose a service level for new patients
You [...] - CPT Update in Brief:
Now's the Time to Update Your Consult Coding
Access modifier 32 for mandated services
The deletion of follow-up inpatient (99261-99263) and confirmatory (99271-99275) consultations [...] - You Be the Coder:
Does Argon Plasma Call for a Special Code?
Question: Our gastroenterologist performed an EGD with Argon plasma coagulation for control of bleeding. What's [...] - CPT Clarifies Conscious Sedation Billing
Look to Appendix G for a complete list of services that include CS
Physician offices have [...] - Get to Know Your New Conscious Sedation Codes
Be sure to document medication and dose when reporting CS
Revisions in CPT 2006 mean you [...] - Medicare Still Won't Pay for CS
In years past, Medicare considered conscious sedation procedures 99141-99142 bundled services in all cases, and [...] - Reimbursement 'Heads-up!':
Medicare Cuts Conversion Factor 4.4 Percent for 2006
You can expect your payments from Medicare to shrink in 2006.
CMS released its 2006 Physician [...] - READER QUESTIONS:
Call on 44385 for Pouchoscopy
Question: My gastroenterologist's documentation states that he performed a -pouchoscopy.- What is this, and how [...] - READER QUESTIONS:
Modifier 78 Helps With Complications
Question: Can we gain reimbursement if our gastroenterologist performs a flexible sigmoidoscopy with control of [...] - READER QUESTIONS:
Separate Documentation Important for Modifier 62
Question: Recently, our gastroenterologist performed an EGD during the same session in which a surgeon [...] - READER QUESTIONS:
Charge Outpatient Consult for Observation
Question: Another doctor asked my GI physician for a consult with a patient who had [...] - READER QUESTIONS:
Stick With 99218-99220 for 8 or Fewer Hours
Question: When is it appropriate to report initial observation (99218-99220) with discharge (99217) versus observation [...] - The Future Of Gastroenterology:
How To Prosper Despite Coming Changes
Presented by Joel V. Brill, MD
The following supplement to Gastroenterology Coding Alert is the transcript [...] - Correction
The December 2005 Gastroenterology Coding Alert included a typographical error on page 96 in the [...]
