Neurosurgery Coding Alert

Expect a 1.5 percent overall increase

CMS has unveiled its "Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2005," and it brings some good news for neurosurgery practices. Specifically, CMS has increased the Medicare conversion factor to $37.8975 for 2005, up from $37.3374 in 2004 - an increase of about 1.5 percent.

Medicare payers use the conversion factor, along with the relative value units (RVUs) assigned to individual CPT codes, to determine reimbursement amounts.

For example, the fee schedule assigns 27.63 RVUs to 63047 (Laminectomy, facetectomy and foraminotomy [unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s) (e.g., spinal or lateral recess stenosis)], single vertebral segment; lumbar). To determine payment, multiply the RVUs by the conversion factor, for a total of $1,047.10.

Payments are also subject to geographic adjustments. In more expensive parts of the country (such as New York City or the San Francisco area), Medicare will pay more to cover higher costs for facility fees, malpractice costs and physician effort, while in less expensive locales Medicare will allot less for the same procedure.
 
View the 2005 fee schedule online at www.cms.hhs.gov/regulations/pfs/2005/1429fc.asp. At the same address, you can also find a complete list of RVUs for all CPT codes in "Addendum B" to the fee schedule update, as well as a complete list of geographic adjustments in "Addendum D."