Part B Insider (Multispecialty) Coding Alert

Medical nutrition therapy will finally have Medicare payments

You work hard for the RVUs--and some of that hard work will be recognized next year.

Good news: The Centers for Medicare & Medicaid Services (CMS) relented on dozens of codes which CMS and the Relative Value Update Committee had slated for decreases after their five-year review. Many of those codes will see much higher work RVUs than originally proposed, according to the 2007 physician fee schedule final rule.

Codes that had their work RVUs increased in response to comments include lesion destruction code 17004, up from 1.58 to 1.80 RVUs; total hip arthroplasty code 27130, up from 15.96 RVUs to 20.09 RVUs; thigh fracture treatment code 27236, up from 12.77 RVUs to 15.58 RVUs; larynx removal code 31365, up from 31.50 RVUs to 35.00 RVUs; sleeve lobectomy code 32486, up from 28.40 to 39.44 RVUs; esophagus removal codes 43108 and 43113; and partial esophagus removal codes 43116-43123.

Heart wound repair codes 33300 and 33305 both saw massive increases in work RVUs, thanks to comments, with 33305 rising from 27.05 RVUs to 70.21 RVUs. In general, many cardiology codes gained work values in response to comments.

Some thorascopy codes in 32651-32665 saw impressive increases, but other codes in that series saw sharp drops to balance the scales.

Also in the final regulation:

- Three medical nutrition therapy (MNT) codes will finally have work RVUs, as recommended by an advisory body in 2000 and ignored by CMS back then. Medicare will now pay for 97802 (0.45 work RVUs), 97803 (0.37 RVUs) and 97804 (0.25 RVUs). Also, Medicare is introducing two new G codes, G0270 and G0271, which correspond to 97803 and 97804 respectively.

- If you live in an area with lower than average costs, you could see a sudden drop in payments in January. That's because a payment -floor- on geographic cost areas, which meant they couldn't be less than the national average, is expiring. So South Dakota will see a 3.35 percent drop in its geographic adjustment, and North Dakota will see a 3.16 percent drop.

- CMS will keep the -discount- on multiple imaging scans on contiguous body parts at 25 percent, instead of increasing it to 50 percent. But CMS is going ahead with a cap on the technical component (TC) of imaging procedures at the outpatient payment level.

- A cap on physical therapy expenses will continue next year, but without any exceptions.