General Surgery Coding Alert

The Health Care Financing Administration (HCFA) modifies its fee schedule for physicians every year. The 2001 national fee schedule Relative Value File, which contains key information about how procedures can be modified to optimize reimbursement, is now available on the HCFA Web site, and may be one of the most important documents a general surgery coder can use.

Many coders associate the HCFA fee schedule with RVUs [relative value units] and reimbursement for specific procedures. But this document contains information far more useful for general surgeons than RVUs, says Susan Callaway, CPC, CCS-P, an independent coding specialist and educator in North Augusta, S.C.

Specifically, the fee schedule addresses the following:

Does the procedure have a global period? If so, how long is it?

Can the procedure be split into professional and technical components?

Do multiple surgery guidelines apply to the procedure?

Can modifier -50 (bilateral procedure) be appended to the service?

What proportion of the procedure is considered pre-, intra- and postoperative?

For multiple endoscopic procedures, what is the base endoscopic code?

This two-part article will examine and explain the various components of the fee schedule. This months installment explains how to obtain the document, and discusses entries about modifiers, RVUs, global days and pre-, intra- and postoperative components of procedures.

Find and Download the Fee Schedule

The easiest way to access the fee schedule is to download it from the HCFA Web site, www.hcfa.gov. From the HCFA home page, select in order the links for Stats and Data, Public Use Data Files and under the heading Physician Fee Schedule Relative Value File RVU01.EXE. Scroll to the bottom of the page to accept the CPT copyright statement. To download the CY 2001 file and obtain a self-extracting copy of the fee schedule, click the file, click accept, select the directory to which you want to save the file and choose save.

When the download is complete, go to the proper directory and double click the saved file. You will be asked to select a directory for the self-extracted files. Choose the directory to which you want to save the files and click unzip. A total of seven files (comprising four documents, each of which is offered in two or more formats) will self-extract to the chosen directory.

Using the Fee Schedule

The most important document the fee schedule itself (named pprrvu01) is offered in three formats. The Excel (.xls) version is the easiest to use. If you dont have Excel software, you can also view the information (in a less user-friendly manner) as a text (.txt) file.

Note: A sample of what youll see when you open the Excel file appears on the enclosed insert. The complete file [...]