Radiology Coding Alert

To many radiology practices, CMS'2003 Physician Fee Schedule contains bone-chilling news: The 4.4 percent conversion-factor reduction means that Medicare payment for most radiology services will not increase. In fact, many radiologists may collect less reimbursement this year than last.

Although the relative value units (RVUs) for many procedures, such as thoracic aortography (75600) and single-view spine studies (72020), remain unchanged, other codes, such as +76810 (Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after fist trimester [> or = 14 weeks 0 days], transabdominal approach; each additional gestation [list separately in addition to code for primary procedure]), suffered a drop from 1.97 work RVUs in 2002 to only 0.98 in 2003.

Because 76810 is now reported as an "add-on" code to CPT 76805 ( single or first gestation), however, practices should net out the same in 2003 as they did last year when performing ultrasounds on twins (0.99 work RVUs in 2003 for twin A[76805] plus 0.98 RVUs for twin B [coded as 76810]). Radiologists can, in fact, report an additional unit of 76810 for a third gestation, and, therefore, reimbursement may actually increase when performing ultrasounds on more than two fetuses.

"From CMS'standpoint, the radiologist is already using his or her resources to examine the first gestation, so the practice expends less time, resources and practice expenses to examine additional fetuses," says Shirley Fullerton, CMBS, CPC, CPC-H, academic director for the Medical Association of Billers.

"The technician must only enter the personal data into the ultrasound computer once, he or she does not change patients or rooms, and the equipment does not need to be cleaned," Fullerton says.

CMS attributed the conversion-factor reduction (from 36.19920 to 34.59200) to a flaw in the Medicare law that only Congress has the power to change. "CMS recognizes that this will be the second year in a row in which physician fees will be affected by a negative update for the conversion factor," CMS Administrator Tom Scully says. "Fixing the formula to provide an accurate update (which we think should be 1.6 percent for calendar year 2003) is essential to restoring trust" between CMS and physicians and patients.

The conversion factor is a resource-based relative value study (RBRVS) that considers geographic allowances (which measure the variances in physician costs in different locations across the country), work units (which reflect the work that the provider does during the procedure), practice expenses (the practice's cost for providing the service), and malpractice expenses (if a high number of malpractice claims are filed against medical specialty groups for a certain procedure, that code will be assigned a higher malpractice expense).

Note: The 2003 work RVUs for selected radiology codes are on page 13.

"The work RVU is currently available, but each carrier will have its own variances based on geographical data," Fullerton says. "I recommend that practices download the Fee Schedule from their carrier as soon as it is available."

The new fee schedule takes effect on March 1. For more information about the 2003 Physician Fee Schedule , visit the CMS Web site at http://www.cms.gov, where you can view the rationale that CMS used to assign many of the RVU calculations.