Radiology Coding Alert

Although many radiology coders were disappointed when CMS cut the 2003 conversion factor, a recent boost will help radiology payments rise this year.

Thanks to a last-minute congressional move, CMS raised the 2003 conversion factor approximately 1.6 percent effective March 1, bringing it slightly higher than where it stood in 2002. According to the U.S. Department of Health and Human Services (HHS) Final Rule published in the Feb. 28 Federal Register, CMS raised the conversion factor to $36.79 for services rendered on or after March 1.

Although the 2002 conversion factor was $36.20, CMS previously announced that it would reduce the 2003 conversion factor to only $34.59 a 4.4 percent decrease. Fortunately, radiology practices need not face this grim reduction after all.

"The action CMS is taking today will ensure that the doctors who treat Medicare patients will see an increase in the payments they get for those services, rather than the reduction previously anticipated," HHS Secretary Tommy Thompson said in a Feb. 26 statement.

Medicare Program Memorandum AB-02-181 states that claims for dates of service Jan. 1 through Feb. 28 "billed with 2002 HCPCS codes but paid at the 2003 rates will automatically be adjusted after July 1, 2003." Therefore, if your carrier reimburses your January and February 2003 claims using the 2003 conversion factor of $36.79 instead of the appropriate rate for January and February services of $36.20, you will receive a refund request for the difference after July 1.

For instance, the nuclear medicine code CPT 78215 (Liver and spleen imaging; static only) carries a work RVU of 3.73 both in 2002 and 2003. If you performed this service in January 2003 but billed it after March 1, your carrier will reimburse you about $137 based on the 2003 conversion factor. You should have received only $135, however, because the carrier should process January and February claims using the 2002 conversion factor. You therefore will receive a refund request for the $2 difference after July 1.

Note: Some carriers may correct this problem before July and, therefore, will reimburse January and February claims at the appropriate 2002 rate. Empire Medicare, the Part B carrier for New Jersey and New York, for example, issued a March 20 announcement that states, "Effective March 18, 2003, claims for services for January and February 2003 dates of service will process correctly at the 2002 Medicare Physician Fee Schedule rate(s)."

For more information, visit the CMS Web site at www.cms.gov.