Orthopedic Coding Alert

To many orthopedists, CMS'2003 Physician Fee Schedule contains bone-chilling news: The 4.4 percent conversion-factor reduction means that Medicare payment for most orthopedic services will not increase. In fact, many orthopedists may collect less reimbursement this year than last.

Although the relative value units (RVUs) for many procedures, such as open ankle arthrodesis (27870) and joint injections (20600-20610), remain unchanged, other codes, such as those for trigger-point injections, had a drop in reimbursement. The RVU for 20552 (Injection[s]; single or multiple trigger point[s], one or two muscle[s]), for instance, dropped from 0.86 to 0.66.

CMS attributed the conversion-factor reduction to a flaw in the Medicare law that only Congress has the power to change. "CMS recognizes that this will be the second year in a row in which physician fees will be affected by a negative update for the conversion factor," CMS administrator Tom Scully says. "Fixing the formula to provide an accurate update (which we think should be 1.6 percent for calendar year 2003) is essential to restoring trust" between CMS and physicians and patients.

New Codes Not Hit Too Hard

On a brighter note, CMS assigns higher-than-expected RVUs to several new codes. For instance, the new arthro-scopic lateral release code (29873) carries a work RVU of 6.00, whereas 27425 (Lateral retinacular release open) is worth only 5.22 RVUs.

"Since each code is surveyed based on its individual description, no formula says that open procedures should outweigh arthroscopic surgeries," says Billie Jo McCrary, CPC, CPC-H, CCS-P, RMC, coding coordinator at Wellington Orthopaedics and Sports Medicine, a Cincinnati-based practice. "In this case, the arthroscopic procedure pays more, but in other cases it does not."

For instance, open ACLreconstructions (27428) traditionally garner slightly higher reimbursement than their arthroscopic counterpart (29888, Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction).

The new arthroscopic rotator cuff repair code (29827) is worth 15.36 work RVUs. Because most practices previously used the unlisted-procedure code (29999) and compared reimbursement to 23412 (Repair of ruptured musculotendinous cuff [e.g., rotator cuff] open; chronic), the new rates represent an increase because 23412 garners only 13.31 work RVUs.

The ankle arthroscopy code (29899) that was introduced in 2003 is worth 13.91 work RVUs the same amount as its open counterpart (27870).

The new Fee Schedule takes effect on March 1. For more information about the 2003 Physician Fee Schedule , visit the CMS Web site at http://www.cms.gov, where you can view the rationale that CMS used to assign many of the RVU calculations.