Pediatric Coding Alert

With a single flourish, President George W. Bush lessened the blow of the anticipated conversion-factor decrease for 2003. Bush signed the budget bill, which eliminates the scheduled 4.4 percent conversion-factor reduction in Medicare physician fees from taking effect on March 1 and raises the rates instead.

Although many pediatricians only occasionally report claims to Medicare, private insurance carriers frequently base their reimbursement on CMS'conversion rate and physician Fee Schedule .

The fiscal year (FY) 2003 appropriations bill (House Joint Resolution 2) rejects the 2003 conversion factor's 4.4 percent reduction and increases the rate about 1.6 percent from the 2002 rate. CMS estimates the new conversion rate to be about $36.78 per relative value unit. The provision does not change other 2003 fee schedule provisions, such as the RVU changes. To calculate the new fee, multiply a code's RVUs by 36.77838, which is 1.6 percent more than the 2002 rate of 36.19920.

Bush signed the bill into law on Feb. 20. The Senate and House passed the bills on Feb.13. Voting 338 for and 83 against, the House passed the spending bill. The Senate passed the 2003 budget bill with a 76-to-20 vote on Feb. 13.

Carriers will pay for services provided after March 1 at the new 2003 conversion-factor rate. Despite the financial good news, billing problems are still ahead.

Payers will reimburse any January and February claims containing 2002 services submitted after March 1 at the 2003 rate ($36.78). The new payment does not apply to these services, which due to CMS'delay in releasing the 2003 Medicare Physician Fee Schedule (PFS) fall under the 2002 rate ($36.20). Carriers will then ask physicians on July 1 for money to recoup any 1.6 percent overpayments. To avoid owing money, CMS encourages physicians to hold these claims until July 1.

For claims containing 2003 codes, carriers will pay at the 2003 rate as of March 1 for all dates of services.

Make sure you know what to expect for January and February codes containing:

2002 services submitted