Neurosurgery Coding Alert

Neurosurgery may duck the harshest fee cuts

The Medicare Physician fee schedule for 2007 is beginning to take shape, and the five-year review of Medicare's relative value units holds big changes for some neurosurgical procedures.
 
Impact: The proposed fee schedule is -a mixed bag [for neurosurgery], but almost all work values have gone up, and practice expense values are mixed. Some of the increases are long overdue,- says Eric Sandhusen, CHC, CPC, director of compliance for the Columbia University department of surgery. 

Here's a look at the possible RVU changes for neurosurgery procedures in 2007. Big RVU Bump Proposed for Craniotomy Code The basics: The public comment period for the proposed fee schedule ended in late August, so no one knows what the final proposed RVUs for next year will be yet. But while these numbers may be revised, they do give coders and physicians a good idea of where the RVU cuts and increases may come from.

Some procedures may have drastically lower RVUs in 2007, but other procedures would have greater reimbursement if the fee schedule passes.
 
For example, last year the RVUs were 46.66 for craniotomy code 61537 (Craniotomy with elevation of bone flap; for lobectomy, temporal lobe, without electrocorticography during surgery). The proposed schedule calls for 60.75 RVUs next year. Code 61538 (... for lobectomy, temporal lobe, with electrocorticography during surgery) could go from 49.04 to 65.03. Each of these proposed changes represents about a $550 increase for the services, depending on your individual geographical adjustments, the final conversion factor, and any across-the-board RVU cuts, Sandhusen says.

Proposed Increases Please Coding Experts The proposed RVU changes for 61537 and 61538 are welcome news to Sharon Hathaway, RHIA, CCS-P, reimbursement manager for the department of neurosurgery at the Medical College of Wisconsin.
 
-I believe that these codes were undervalued in terms of the amount of work and liability to the physician,- she says.

Another major RVU change could come with craniectomy code 61312 (Craniectomy or craniotomy for evacuation of hematoma, supratentorial; extradural or subdural).

The schedule reports that the work RVUs (wRVUs) could be pushed from 24.53 (2006) to 30.30 (2007) for the procedure. The increase is being proposed for 61312  because -the increased use of anticoagulants by these patients has increased the intensity of the intra-service work,- according to the Federal Register Volume 71, No. 125. Total RVUs might go from 45.95 to 51.71--almost $225 in added payment for the 61312 code.
 
Hathaway says that the Federal Register's reasoning on 61312 makes good sense. Other neurosurgery procedures that would enjoy a pay bump next year if the fee schedule passes include:

- 61538 (... for lobectomy, temporal lobe, with electrocorticography during surgery). Proposed wRVU increase: from 26.77 to 39.31.

- 61697 (Surgery of complex intracranial [...]