General Surgery Coding Alert

Proper modifier use, RVU information and more are just a download away

If you are looking for a one-stop resource for many common coding queries, Medicare's Physician Fee Schedule database provides a wealth of coding information in an easy-to-use format. Here are three great reasons you'll want to refer to the fee schedule database. Number 1: Track RVUs You can determine approximate Medicare reimbursement for any procedure by referring to the Physician Fee Schedule database (see "Easy Instructions to Download the Fee Schedule Database" later in this issue for instructions on accessing the database).

The database provides a thorough breakdown of relative values for both facility and non-facility settings. Surgery practices will be interested in one of two figures:

1. In-office: For services the surgeon provides in his own office, look to the "Fully Implemented Non-Facility Total" column. This number describes the relative value units (RVU) allotted for all aspects of a particular procedure (physician work, malpractice expense, equipment costs, etc.).

By multiplying the RVU total in this column by the national conversion factor (37.8975), you can arrive at an approximate reimbursement value, says Anita L. Carter, LPN, CPC, an instructor at A+ Medical Management and Education, a school for billing and coding in Absecon, N.J. Example: The surgeon performs diagnostic colonoscopy (45378, Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen[s] by brushing or washing, with or without colon decompression [separate procedure]) in the office.
 
To determine payment, look to the "Fully Implemented Non-Facility Total" column to find 10.13 RVUs. Multiply this by 37.895 to arrive at an approximate payment of $384. This number represents a national average payment. Actual reimbursement varies according to geographic location and cost-of-living adjustments. 2. In the hospital: For services the surgeon provides in a facility setting, add together totals from "work RVU" and "MP [malpractice] RVU" columns and multiply this total by 37.8975 to determine reimbursement. In this case, the surgeon will gain payment only for his effort and "expense," while the facility will earn separate reimbursement for equipment costs, etc. Example: The surgeon performs colostomy revision (44340, Revision of colostomy; simple [release of superficial scar] [separate procedure]) in the hospital operating room. Add together the "work RVU" and "MP RVU" columns to arrive at an RVU total of 8.69 (7.71 + 0.98). Multiply the RVU total by the national conversion rate for an approximate payment of $329 (8.69 x 37.8975). The hospital will receive additional payment for use of its facility, staff, etc. How it helps you: Knowing Medicare relative values can help in several ways, including allowing you to monitor your carrier's payments for accuracy, Carter says. "[The database] is a great resource for coders, billers and students to determine the approximate [...]