Radiology Coding Alert

Take the good with the bad under Medicare's 2005 Physician Fee Schedule 

The 2005 Medicare Physician Fee Schedule may be the answer to your fee prayers in the new year - depending on your specialty. The final rule predicts a 4 percent increase in the total Medicare-allowed charges for interventional radiology, 2 percent for general radiology, and only 1 percent for radiation oncology.

Celebrate Interventional Advances

The conversion factor for 2005 is $37.8975. This amount is up 1.5 percent from last year ($37.3374) but actually less than in 2001 ($38.2581). So how did IR get a 4 percent boost?
 
An "in-office [nonfacility] reimbursement differential was added in 2005 for selective and nonselective  catheterization, PTA [percutaneous transluminal angioplasty], and some drainage/tube procedures," says Dawn Hopkins, senior manager for reimbursement with the Society for Interventional Radiology. "Historically, these services were only provided in a hospital setting, and the practice expense differential for the office setting was just never established. SIR has been working on the development of a differential in reimbursement for these services over the past few years. We are extremely pleased that CMS elected to enact these changes for 2005."

Cope With Nuclear Medicine Disappointment

Medicare decided not to accept the new PET and PET/CT codes (78811-78816), says Denise Merlino, CNMT, MBA, FSNMTS, coding and reimbursement adviser to the Society of Nuclear Medicine (SNM), who staffs the SNM Coding and Reimbursement Committee. Merlino says that several professional societies will be speaking with CMS about the issue, but it doesn't appear that the immediate future holds any changes.
 
The Fee Schedule does provide relative value units (RVUs) for the professional components of these codes (see charts, "Chart the Changes to 2005 Radiology RVUS", this issue). These professional RVUs could be used by CMS and private payers, Merlino says. She explains that the issue of Medicare payment for the professional component is still up in the air.
 
Regarding the technical RVUs, Merlino says, "We are hoping CMS will also publish the RUC [Relative value scale Update Committee] approved technical RVUs even if they choose not to use them, because private payers may choose to use the RUC-approved values and the new PET and PET/CT codes."