Orthopedic Coding Alert

You won't feel as big a crunch, thanks to neutrality adjustment.

CMS released the Medicare Physician Fee Schedule for this year when they sent it to the Office of the Federal Register. Although the physician community was told they would be seeing a 1.1 percent increase, the conversion factor ultimately is a 5.4 percent reduction.

Despite a lower conversion factor (CF), however, the news isn't all bleak. In fact, your practice may see an increase in reimbursement this year. Here's what you need to know to be ready.

Don't lose heart when you see CMS's 2009 conversion factor of $36.066 -- a drop from last year's $38.0870. CMS attempts to make up for the practice expense reduction, which lowered the conversion factor by 6.5 percent, by boosting the conversion factor 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: The amount your claims will bring in this year depends on the specialty you bill for. Some specialties, such as audiology (10 percent decrease) and cardiology (2 percent decrease), will get hit hard. But while some specialties won't fare as well this year, others will see a distinct boost in reimbursement. For example, general surgery practices will see a 3 percent scheduled increase to their pay, and emergency medicine billers can expect their claims to bring in an additional 4 percent in 2009. Orthopedics has a 0 percent change.

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 www.cms.hhs.gov/physicianfeesched/downloads/CMS-1403-FC.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. Had the planned 10 percent decrease in Medicare fees taken place, the result would have been a 16.5 percent reduction in the conversion factor, and that is huge," she added.

CMS reassigned RVU values for many procedures for 2009. While the RVUs for several procedures went down, your non-geographically adjusted reimbursement for the most commonly-reported code, 99213 (Office or other outpatient visit ...) rose. Whereas you were allowed $58.90 for 99213 (not including geographic adjustment) in 2008, you-ll bring in $61.31 for this service in 2009.

Allowances (non-geographically adjusted) for 99214 (Office or other outpatient visit ...) will rise from the 2008 rate of $89.89 to $92.33 this year. The allowance you-ll receive for some procedures will also rise.

For example, 17000 (Destruction [e.g., laser surgery, electrosurgery, cryo-surgery, chemosurgery, surgical curettement], premalignant lesions [e.g., actinic keratoses]; first lesion) will increase from $67.41 to $69.97 (again, not considering geography).

Your practice may garner an additional 2 percent in bonus payments 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 health care 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 the Medicare program for services that a physician rendered up to 27 months from the date of mailing the applications, prior to the physician being credentialed to participate in the Medicare program. But in the future, that 27-month period shrinks to a 30-day window, according to the final rule.

Have your say: To review the fee schedule and learn how to submit comments, visit the CMS Web site at www.cms.hhs.gov/physicianfeesched/downloads/CMS-1403-FC.pdf.