Neurosurgery Coding Alert

But you won't feel as much of a crunch, thanks to a budget neutrality adjustment.

CMS has released the Medicare Physician Fee Schedule for next year. Despite a lower conversion factor, the news isn't all bleak. In fact, your neurosurgery practice won't see a change in reimbursement next year. Here's what you need to know now.

Don't lose heart when you see CMS's 2009 conversion factor of $36.0666 -- a drop from this year's $38.0870. CMS attempts to make up for the lower conversion factor by boosting the budget neutrality adjustment by 1.1 percent. Therefore, despite the lower conversion factor, the relative value units (RVUs) for some procedures have gone up.

What it means to you: While some specialties won't fare as well, neurosurgeons will see a 0 percent scheduled change to their reimbursement. Some specialties will see increases, but others will see decreases of 3 and 4 percent, so consider yourself lucky to have no change at all.

Where to find it: The specialty information, which comes from Table 48 in the Fee Schedule Final Rule, shows how the new RVU changes will affect each specialty. You can check other specialties online at http://edocket.access.gpo.gov/2008/pdf/E8-26213.pdf.

"There is a 6.5 percent, five-year practice expense reduction that has been in the works for the past five years, so without the 1.1 percent increase, we would be seeing a 6.5 percent overall decrease in reimbursement," says Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions. "Instead, we are now seeing a 5.4 percent decrease."

CMS reassigned RVU values for many procedures for 2009. While the RVUs for several procedures went down, your reimbursement for the most commonly reported code, 99213 (Office or other outpatient visit -), rose. Whereas you currently collect $58.90 for 99213 (not including geographic adjustment), you-ll bring in $61.31 for this service in 2009. Similarly, payments for 99214 (Office or other outpatient visit ...) will rise from the current rate of $89.89 to $92.33 next year.

Your practice may garner an additional 2 percent bonus if you participate successfully in the PQRI program. Another incentive next year will be that your physicians are eligible to earn 2 percent of their total Medicare allowed charges if they adopt e-prescribing systems. "E-prescribing can greatly reduce the number of medication errors that jeopardize the health and safety of Medicare patients and waste precious healthcare dollars treating conditions that never should have happened," said CMS Acting Administrator Kerry Weems in an Oct. 30 statement.

Take note: You do not have to have an electronic medical record (EMR) system to perform e-prescribing, Cobuzzi says. "There are many systems that are being made available that are stand-alone e-prescription systems that are substantially less costly than a full-blown EMR." The physician will have to register to be considered for the 2-percent bonus from e-prescribing, and then report e-prescription activity on 50 percent of the Medicare patients he sees.

Reporting includes three G codes, which indicate one of three conditions: 1) that the physician used an e-prescription, 2) that the physician did not write a prescription, or 3) that the physician wrote or phoned in some or all prescriptions due to patient request, to comply with state or federal law, because the pharmacy's system could not receive the data electronically, or because the prescription was for a narcotic or other controlled substance.

The fee schedule final rule dramatically changes how you can bill when you-re waiting for your physician to acquire Medicare credentialing status.

Currently, you can retroactively bill Medicare for services that a physician rendered up to 27 months prior to the physician being enrolled to participate in the Medicare program. But in the future, that 27-month period shrinks down to a 30-day window, according to the final rule.

To review the fee schedule, visit the Federal Register Web site at www.http://edocket.access.gpo.gov/2008/pdf/E8-26213.pdf.