General Surgery Coding Alert

Plus: Thoracic, integumentary rates on the line.

'Tis the season for another round of tense waiting to see if you'll get a dramatic reduction in 2012 Medicare payments for your general surgical services. "The calendar year 2012 Physician fee schedule [PFS] conversion factor is $24.6712," notes the physician 2012 Medicare fee schedule Final Rule, printed in the Nov. 28 Federal Register -- and that could mean a big cut in your pay.

Look for Congressional Relief

The conversion factor (CF), scheduled to go into effect Jan. 1, 2012, amounts to a dismal 27.4 percent cut compared to the current rate of $33.9764. CMS acknowledges that this massive cut may not be set in stone, stating, "While Congress has provided temporary relief from these reductions every year since 2003, a long-term solution is critical. We will continue to work with Congress to fix this untenable situation so doctors and beneficiaries no longer have to worry about the stability and adequacy of their payments from Medicare under the Physician Fee Schedule."

Physician advocacy organizations were quick to decry the cuts. "Payments for Medicare physician services have fallen so far below increases in medical practice costs that there is a 20 percent gap between Medicare payment updates and the cost of caring for seniors," said AMA president Peter W. Carmel, MD, in a Nov. 1 statement.

Even CMS officials agreed that the 27.4 percent cut would be devastating, but remained hopeful that the government might rectify the situation before the pay cuts kick in. "This payment rate cut would have dire consequences that should not be allowed to happen," said CMS administrator Donald Berwick, MD, in a Nov. 1 statement. "We need a permanent SGR fix to solve this problem once and for all. That's why the President's Budget and his Plan for Economic Growth and Deficit Reduction call for permanent, fiscally responsible reform and why we are committed to working with the Congress to achieve a permanent and sustainable fix."

Recall 2011 fix: Last December, Congress voted to stave off a 25 percent cut to your Medicare pay. But that vote kept the cuts at bay only through Dec. 31 of this year -- and that date is right around the corner. Effective January 1, your Medicare pay is set to drop again based on the new 2012 Fee Schedule information, unless Congress intervenes to reverse the cuts.

Evaluate RVU Changes

The CF is only part of your payment equation -- it's the multiplier you use with relative value units (RVUs) to determine pay for a specific service. That means you need to anticipate revised RVUs for procedures your surgeon performs.

The 2012 PFS updates RVUs for the following codes that might impact your practice:

Integumentary codes

• 16020 (Dressings and/or debridement of partial-thickness burns, initial or subsequent; small [less than 5% total body surface area]) updates to work RVU of 0.71 (was 0.80 in 2011)
• 16025 (... medium [e.g., whole face or whole extremity, or 5% to 10% total body surface area]) updates to a work RVU of 1.74 (was 1.85 in 2011)

Thoracic codes

• 32100 (Thoracotomy, major; with exploration and biopsy) assigned a work RVU of 13.75 (was 16.16 in 2011).
• 32601 (Thoracoscopy, diagnostic (separate procedure); lungs and pleural space, without biopsy) receives an increased work RVU of 5.50 (was 5.45 in 2011)
• +38746 (Thoracic lymphadenectomy, regional, including mediastinal and peritracheal nodes [List separately in addition to code for primary procedure]) assigned a work RVU of 4.12 (was 4.88 in 2011).

Other codes considered for 2012 work value changes held steady, including 10 esophageal codes that the AMA relative value scale update committee (RUC) recommended for significant increase. Instead, work RVUs will remain the same for esophagogastric fundoplasty (43325-43328) and paraesophageal hiatal hernia repair (43332-43338) in 2012.

Overall RVU impact: For general surgery practices, CMS expects average revenue to increase by 1 percent overall based solely on 2012 practice expense (PE) RVU changes.