General Surgery Coding Alert

Look for tweak to merit-based pay adjustments, too.

With CMS's recent release of the proposed rule for the 2018 Medicare Physician Fee Schedule, the word on the street is that you can expect some ups and downs for your general surgery practice pay next year.

Good news: The proposed conversion factor (multiplier for procedure RVUs, or relative value units) doesn't change much in 2018 - up to 35.9903 compared to 35.8887 for 2017.

Bad news: But CMS states in the proposed rule that payment for general surgery services across the board will decline by one percent next year.

Caveat: Of course, how much your payment actually changes will depend on what services/volumes your surgeons perform. Read on to learn which services will see the largest increases and decreases in pay.

See What's Looking Up

The 2018 proposed rule significantly increases pay for certain tracheostomy services, based on an increase in work Relative Value Units (RVUs) for what CMS characterizes as "potentially misvalued codes." Look for the following percent increase in work RVUs for these codes:

• 45 percent increase for 31601 (Tracheostomy, planned [separate procedure]; younger than 2 years)
• 31 percent increase for 31603 (Tracheostomy, emergency procedure; transtracheal)
• 45 percent increase for 31605 (Tracheostomy, emergency procedure; cricothyroid membrane)
• 22 percent increase for 31610 (Tracheostomy, fenestration procedure with skin flaps)

See What's Looking Down

On the other hand, you can expect the work RVUs for 31600 (Tracheostomy, planned [separate procedure]) to decrease by 22 percent.

Other notable codes on the chopping block for work RVU reduction include 31267 (Nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxillary sinus), to decrease by 24 percent, and 19303 (Mastectomy, simple, complete) to decrease by 5 percent.

Look for Physician Value-Based Modifier Relief

To ease transition to the Merit-based Incentive Payment System (MIPS), the proposed rule introduces a reduction of the automatic downward payment adjustment from -4 percent to -2 percent if you don't meet the minimum quality reporting requirements. That's for a group of 10 or more clinicians. You can also expect relief from -2 percent to -1 percent adjustment for groups under 10 surgeons.

And more: Keep watching General Surgery Coding Alert for more info on how the MPFS proposed rule, and later in the fall, the final rule, might impact your general surgery practice.

Resource: You can access the MPFS proposed rule in the July 21, 2017 Federal Register at www.federalregister.gov/documents/2017/07/21/2017-14639/medicare-program-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other-revisions.