Part B Insider (Multispecialty) Coding Alert

Published on Fri Oct 09, 2009 PDF

Bonus: CMS increases pay for office visit codes.

Get ready for another year of nail-biting to find out if your Medicare payments will be slashed. "The update to the physician fee schedule conversion factor is -21.2 percent for CY 2010, notes the 2010 Medicare Physician fee schedule Final Rule, printed in the Federal Register that will be published on Nov. 25.

Traditionally, Congress has stepped in to reverse such dramatic cuts before they take place, but unless that happens this year, you'll face a conversion factor of $28.4061 effective Jan. 1, according to calculations in the Federal Register.

Many physician practices expressed angst at such low reimbursement rates, with some indicating that they would become non-par with Medicare if the cuts take effect. "Physicians have been getting more disgruntled over the past several years with the threat of cuts, and if their reimbursements are cut by such an egregious amount, this will finally send them over the edge," says Charlene Burgett, MS, CMA (AAMA), CPM, CPC, CMSCS, administrator with North Scottsdale Family Medicine. "It is becoming more and more difficult dealing with all health plans, especially Medicare," Burgett says. "It is not going to be worth accepting Medicare due to the fact that there is more red tape and government bureaucracy with nothing to show for it if there is a reduction in reimbursement."

Plus: Get used to skipping the 99241-99255 section of CPT.

"Beginning January 1, 2010, we will eliminate the use of all consultation codes (inpatient and office/outpatient codes for various places of service except for telehealth consultation Gcodes) on a budget neutral basis by increasing the work RVUs for new and established office visits" and for initial hospital and initial nursing facility visits, the Final Rule notes.

The elimination of consult codes will hurt specialty practices in particular, says Susan Vogelberger, CPC, CPC-H, CPC-I, CMBS, CCP-P, CEO of Healthcare Consulting and Coding Education.

CMS will raise payment for the other E/M codes to try and offset the consult loss. For instance, you'll see a 7 percent increase for 99214, with physician work RVUs rising to 1.50 from the 2009 rate of 1.42. However, certain specialists still end up losing money. See page 316 for specialtyspecific information.