Neurosurgery Coding Alert

Midyear switch means about 1 RVU more for bone density study.

According to a recent CMS communiqué, there will be a slight degradation of the Medicare conversion factor beginning on June 1.

The $kinny: CMS is only changing the conversion factor from $36.0846 to $36.0791, states CMS Transmittal 700, published May 10. Medicare administrative contractors (MACs) will use this conversion factor to calculate your payments after May 31.

The transmittal failed to address the 800-pound gorilla in the room, however ��" the 21 percent pay cut neurosurgery practices are scheduled to face on June 1. (At press time, Congress had not addressed the pay cut. Check out the next issue of Neurosurgery Coding Alert to see how it all shakes out.)

Silver Lining: See More Cash for DEXAs

The transmittal contained some very good news for neurosurgery coders whose surgeons perform dual-energy x-ray absorpitometry (DEXA) scan imaging (77080, Dual-energy Xray absorpitometry [DXA], bone density, 1 or more sites; axial skeleton [e.g., hips, pelvis, spine]).

The new transitioned non-facility relative value units (RVUs) for 77080 are 2.70; the year's initial fee schedule listed 1.71 RVUs for this scan.

When combined with the conversion factor of $36.0791, that makes DEXA pay about $97 per encounter, a $36 increase over the pre-revision total of about $61.

Keep in mind: DEXA payment is subject to frequency rules. In some cases, you may not know when the patient last had a DEXA scan. In these cases, "I would, along with the patient, make the call to Medicare to see if we could find out if or when there was a previous DEXA," says Kim French, CIRCC, with Crouse Radiology Associates in Syracuse, N.Y.

"It's worth the extra effort for good patient care (you can then obtain the previous results for comparison) and public relations. These days, there is a lot of competition and with reimbursement decreasing, little things like this are critical for survival," French explains.

If you cannot locate the date of the previous DEXA scan, you'll want to ask the patient to sign an advance beneficiary notice (ABN), says Barbara J. Cobuzzi, MBA, CPC, CPCH, CPCP, CENTC, CHCC, with CRN Healthcare Solutions in Tinton Falls, N.J.

The 77080 pay boost is retroactive to Jan. 1, 2010, according to CMS.

For more information on DEXA payment and the conversion factor, visit www.cms.gov/transmittals/downloads/R700OTN.pdf.