Neurology & Pain Management Coding Alert

Plus:  Find out how the new physician fee database treats your 2006 CPT codes

Don't be surprised when you see reimbursement for most of your common services drop in 2006. This year's adjustment could swallow up more than 4 percent of your bottom line.

The Centers for Medicare & Medicaid Services released its 2006 Physician Fee Schedule in early November, and it includes an approximate 4.4 percent reduction in the Medicare conversion factor. The conversion factor, 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 36.1770 (down from 37.8975 in 2005).

The ripples from this drastic cut could spread well beyond Medicare, -as more than half of U.S. payers establish their fee schedules using the Medicare system,- says Elizabeth Woodcock, MBA, FACMPE, CPC, founder and principal of Woodcock & Associates in Atlanta.

Dollars-and-cents example: The 2005 fee schedule assigns 4.95 nonfacility total RVUs for the global package of 95816 (Electroencephalogram [EEG]; including recording awake and drowsy). In 2005, this equals an average payment of $187.59 (4.95 RVUs x 37.8975 conversion factor). For 2006, the RVUs for this EEG service inch forward to 4.96, but average payment for the procedure falls to $179.44 (4.96 x 36.1770) conversion factor), or about $8 less for the same physician work.

Voice your opinion: Congress can still step in with a new budget package that includes a 1 percent increase to your payments. You can send a request for action to your congressional representatives through the American Medical Association by visiting http://capwiz.com/ama/mail/oneclick_compose/?alertid=8104801.

Keep reading Neurology Coding Alert for news of any government interventions.

Get a Break With New Chemodenervation Guidance Codes

While most neurologists were glad to see new add-on codes for guidance in conjunction with chemodenervation (64612-64614) in CPT 2006, many worried they might lose out on payment for +95873 (Electrical stimulation for guidance in conjunction with chemodenervation) and +95874 (Needle electromyography for guidance in conjunction with chemodenervation).

Good news: The 2006 fee schedule alleviates this fear, assigning 0.77 nonfacility RVUs to electrical stimulation and 0.78 RVUs to needle electromyography.

The new allowance is on par with the 0.78 RVUs assigned to the code that you previously used to report guidance (95870, Needle electromyography; limited study of muscles in one extremity or non-limb [axial] muscles [unilateral or bilateral], other than thoracic paraspinal, cranial nerve supplied muscles, or sphincters). Of course, with the new drop in the conversion factor, the payment for those 0.78 RVUs will be shaved from $29.56 to $28.22.

-In 2005, CMS was going to outlaw all extra codes for EMG guidance, but with specialty-society input they agreed to allow 95870. This is just a continuation of the same policy with different codes. It could have been worse,- says Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine.

Take a look at how other new neurology codes are holding up to the 2006 physician fee database: