Pulmonology Coding Alert

Remember that huge cut to the conversion factor rate that was supposed to go into effect Jan 1? It's been delayed -- which is good news for any practice that did not want their services devalued by almost 22 percent. Despite CMS's plans to downgrade your 2010 conversion factor by 21.29 percent, Congress stepped in at the last minute and offered you a temporary reprieve.

Development: On March 3, the Senate extended the delay in the implementation of the said cut by passing a bill that was previously passed by the House. This bill provides the legislative branch with 30 days to resolve the sustainable growth rate (SGR) formula travesty before the cuts take effect. That extension would have ended on April 1, 2010. However, Congress voted again on March 17 to delay the decrease in the conversion factor until May 1, 2010.

Background: President Obama signed the temporary pay fix into law on Dec. 19. CMS subsequently issued MLN Matters article MM6796, which announced that due to relative value unit (RVU) adjustments, the conversion factor during the two-month temporary pay fix period would not remain at the 2009 level of $36.0666, but would instead rise about two cents to $36.0846.

This temporary fix is being considered a "bridge" to help physician payments stay stable while a more permanent SGR fix is still up in the air, as Congress hasn't made a decision on whether to permanently change the SGR formula or add a further delay past May 1, 2010 before its implementation.

Plus: As a result of the Senate-passed temporary extension, CMS backed out of its original decision to hold payments for Medicare services until March 15. Instead, effective immediately, CMS  will facilitate the payment on claims with dates of service March 1 and later.

The original claims hold was to ensure that the adjusted conversion factor and the RVUs for 2010 come through properly on your claims, according to Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CENTC, CHCC, president of CRN Healthcare Solutions in New Jersey. (To read MLN Matters article, visit www.cms.hhs.gov/MLNMattersArticles/downloads/MM6796.pdf.)