Pediatric Coding Alert

Our financial experts do the fee schedule number crunching for you

When you sort out the 2007 National Physician Fee Schedule's relative value unit (RVU) hikes, procedure cuts, and conversion-factor slash, the overall picture isn't rosy.

Initial gain: "The average PCC customer -- if he codes exactly the same in 2007 as he did in 2006 -- will receive an overall 2 percent increase in RVUs," says Chip Hart, director of Physician's Computer Company (PCC) Pediatric Solutions consulting group in Winooski, Vt. This matches the numbers the American Academy of Pediatricians found. "But as preventive medicine services become a larger percentage of the work pool" as the medical community continues to emphasize the importance of well care, "we will probably see a decrease."

Hitch: More RVUs doesn't necessarily translate into increased pay. "Most pediatricians will see an increase in [payments for] 99204, 99205, 99213, 99214 and 99215 in their geographic areas; however, these increases are offset by the decreases in the other office visit codes," says Karen Walker, administrator at Pediatric Services of Florida in
St. Petersburg. For example, the approximate $7 gain in the most frequently used 99213 will not be realized due to the decreases in well visits.

Bottom line: Based on a sample of the 20 frequently used pediatric codes, pediatricians will see an overall negative 3 percent impact, Walker says. "The reduction in the conversion factor results in an overall negative reimbursement impact for 2007." Her findings, which use national transitional values without any geographic adjustments for illustrative purposes, follow: