Pulmonology Coding Alert

Hint: Expect the status quo in chest x-ray payments, despite new codes.

As pulmonology practices prepare their billing systems for 2018, it's a good time to take note of any new payment values that will take effect on Jan. 1. CMS released its Medicare Physician Fee Schedule Final Rule on Nov. 2, which includes 1,250 pages of material that confirms the policies that the agency has set for the new year. Pulmonology Coding Alert combed through the document to extract the most relevant information - read on for more.

Note New Conversion Factor

CMS has set the final 2018 conversion factor at $35.99, an increase over the current conversion factor, which is $35.89. Remember that to calculate the fee for a Medicare service, you'll multiply the conversion factor by the total relative value units (RVUs). For instance, code 99213 currently has a total RVU of 2.06 for 2017, which comes out to a fee of $73.93 when multiplied by the 2017 conversion factor of 35.89.

Pulmonary test payments: CMS has now assigned 2018 work RVUs to the new codes that CPT^® introduced for the following pulmonary tests:

• 94617: - Exercise test for bronchospasm, including pre-and post-spirometry and pulse oximetry : Work RVU is 0.70
• 94618 - Pulmonary stress testing (e.g., 6-minute walk test), including measurement of heart rate, oximetry, and oxygen titration, when performed: Work RVU is 0.48

The above two codes replace soon-to-be-deleted code 94620 (Pulmonary stress testing; simple [e.g., 6-minute walk test, prolonged exercise test for bronchospasm with pre- and post-spirometry and oximetry]) effective Jan. 1. This code had a work RVU of 0.64.

These values make sense because 94617 reflects more work than the six-minute walk test, says Carol Pohlig BSN, RN, CPC, ACS, senior coding and education specialist at the Hospital of the University of Pennsylvania. "Code 94620 has had to account for several different forms of testing and had a median value. Now the separate codes can better account for the simple vs. more complex work."

New Chest X-Ray Codes Mirror Old Codes' Values

Coders won't find any earth-shattering values when it comes to the new chest x-ray codes that are set to debut on Jan. 1. CMS has assigned the following work RVUs to the new codes:

• 71045 - Radiologic examination, chest; single view: Work RVU is 0.18, which is identical to what the 2017 work RVU has been for 71010 (Radiologic examination, chest; single view, frontal), which will be deleted effective Jan. 1.
• 71046 - Radiologic examination, chest; 2 views: Work RVU is 0.22, which matches the same RVU as soon-to-be deleted code 71020 (Radiologic examination, chest, 2 views, frontal and lateral)
• 71047 - Radiologic examination, chest; 3 views: Work RVU is 0.27 (no matching code exists for 2017)
• 71048 - Radiologic examination, chest; 4 or more views: Work RVU is 0.31, which matches the RVUs of 71030 (Radiologic examination, chest, complete, minimum of 4 views), which will be deleted on Jan. 1.

Resource: To read more about the Final Rule, see CMS' Fact Sheet at https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-11-02.html.