Urology Coding Alert

Good news: Despite blanket cuts, expect a boost in E/M reimbursement

Your Medicare reimbursement could take a sharp dive next January, especially if you perform any imaging services. CMS roared ahead with several controversial proposals in the final regulation for the physician Fee Schedule , including:

• A 5.0-percent cut to your conversion factor (down from 5.1 in the proposal)

• A cap on the technical component of imaging services at the lower hospital outpatient rate

• Sweeping changes to practice-expense relative value units (RVUs), phased in over four years

• An across-the-board cut to work RVUs to pay for sharp increases in work RVUs for some evaluation & management codes.

Brace Yourself for 'Devasting' Cuts

Physician associations had asked CMS to revise, or delay, some of these changes, but to no avail. Also, many physician societies had asked CMS to replace the cut to work RVUs with a cut in the overall conversion factor, to spread out the pain. But CMS went ahead with the work RVU cut.
 
"The cuts in my opinion are devastating to us as specialists," says Chandra L. Hines, business office manager for NC Urological Associates Inc. in Raleigh, N.C. "I have to look at the coming year, and discussions have to be had as to how we can shift our way of practicing good medicine for our patients and receive maximum reimbursements."

CMS accepted all 400 of the Relative Value Unit Update Committee's (RUC) recommendations for changing the RVUs of codes. CMS also went ahead with 150 of its own recommendations, acting deputy administrator Herb Kuhn told a conference call with reporters.

Watch for Imaging Changes

CMS has also ruled that, in an office, technical imaging services will be paid at a rate no higher than the fee that a hospital outpatient department would receive for the same service. For urology, this will affect your reimbursement on the technical components for codes CPT 76857 (Ultrasound, pelvic [nonobstetric], real time with image documentation; limited or follow-up [e.g., for follicles]) and 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation), says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York in Stony Brook.
 
What it means: Based on the 2006 fee schedule, you would have received $67.08 (based on the standard, unadjusted fees) for 76857-TC (Technical component). The hospital outpatient department amount is $62.44, down 6.92 percent from what you would receive for performing the technical component in your office. The unadjusted payment in the office for 76942-TC in 2006 is $110.66 and the hospital outpatient department payment is $73.66, which is a drop of 33.44 percent.

"In New York, area # 2, 2007 Medicare reimburse-ment for 76857-TC will drop from $89.66 to $81.26, a decline of 9.36 percent, while reimbursement for 76942-TC will drop from $154.52 to $95.35, a decline of 38.29 percent," Ferragamo explains.

Keep in mind: "CMS is not going to impose the additional 25 percent cut in the technical component imaging services performed on contiguous body areas in the same session, so that's good for urologists," Ferragamo also points out.

Look at the E/M Bright Side

You should still notice some pretty "powerful" increases in your reimbursement for mid-level E/M codes, in spite of the cut to the conversion factor and the across-the-board reduction in work RVUs, Kuhn promised. 

Of the 33 E/M codes affected for 2007, 14 will see a payment increase and 19 a payment decrease. See the chart at the right for a few examples of the standard national unadjusted new fees for 2007 compared with last year's unadjusted fees.

Bottom line: It could be March, or even April, before Congress is able to revoke the 5-percent cut that's scheduled to hit the conversion factor in January.