Otolaryngology Coding Alert

Although otolaryngologists will benefit from Medicare's slight rate hike in 2005, your total payment could be up or down depending on your code make-up.

CF Is Up 1.5 Percent

You'll enjoy a small increase - 1.5 percent to be exact - in the 2005 conversion factor (CF) to $37.8975 from the 2004 CF of $37.3374.

How it works: To calculate how much a service or procedure pays approximately, multiple the code's relative value units (RVUs) by the CF.

Editor's note: How much Medicare will specifically pay for the code also depends on the geographic adjustment factor for your area and whether a facility - such as a hospital - or non-facility - such as an office - provided the service.

Example: Code 99213 (Office or other outpatient visit for the evaluation and management of an established patient ...) contains 1.39 RVUs in the non-facility setting and pays $52.68 (1.39 x $37.8975) in 2005. In 2004, the office visit had 1.41 RVUs and paid $52.65 (1.41 x $37.3374).

Specialty Impact Depends on Your Use

Even though a comparison of the 2004 and 2005 total RVUs for the top 128 otolaryngology codes shows a decrease of 0.25 percent in total RVUs, utilization rates show a specialty increase.
 
"Comparison of the total change in reimbursement for 2005 indicates an increase of approximately $8.2 million for the specialty as a whole," reports the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) bulletin. "The 2005 increase, despite the small decrease in total RVUs, can be explained by higher utilization (allowed services) in those services with significant increases in the RVUs."

Resources: For additional information regarding the AAO-HNS's opinion on Medicare's 2005 Physician fee schedule, visit www.entlink.net/press/bulletin/Schedule.cfm. You may download Medicare's physician fee schedule from the CMS Web site at www.cms.hhs.gov/regulations/pfs/2005/1429fc.asp.