Pediatric Coding Alert

Question:What is the conversion factor for 2008?

North Carolina Subscriber

Answer: The conversion factor for 2008 -- 38.0870 -- reflects a 0.5 percent increase from the 2007 rate of 37.8975. Congress passed the Medicare, Medicaid and SCHIP Extension Act of 2007 on Dec. 19, replacing the scheduled 10.1 percent Medicare pay cut for 2008 with the increase.

Many private payers base payments on a percentage of the Medicare fee schedule. For instance, if an insurer pays you 120 percent of the 2008 Medicare fee schedule, you would calculate the national payment by multiplying the procedure's total relative value units (RVUs) by 45.7044 (38.0870 x 120 percent). So 99213, which has 1.68 transitional nonfacility total RVUs in 2008, would pay an unadjusted rate of $76.78.

Catch: The law expires on June 30, so Medicare allowances for the remainder of 2008 are still up in the air. "We could be right back at square one this summer," says Cyndee Weston, executive director of the American Medical Billing Association in Sulphur, Okla.