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Urology Coding Alert

Fee Schedule Update:

Prepare for a Mixed Bag of Urology RVUs in 2005

Published on Sat Jan 01, 2005

You'll see some payments drop 80 percent - and others rise 500 percent

Brace yourselves, coders: You'll be earning about $500 less for ureteroscopies through ureterostomies performed in the office in 2005 - but you also may see up to $1,340 more for treatment of minor bladder lesions.

Those are two of the surprises waiting for you in the 2005 physicians' fee schedule. Last month, we gave you the good news: a 1.5 percent increase in payments across the board for physician services next year. CMS has raised the conversion factor in the 2005 physicians' fee schedule, which takes effect January 1, 2005, from $37.3374 to $37.8975, says Robert Tait, CPC, billing and coding specialist for the urology department of the Lahey Clinic in Quincy, Mass. (See "RVU Update: Expect More Pay for Evaluation and Management Codes in 2005" in the December 2004 Urology Coding Alert.) Multiplying the total relative value units (RVUs) assigned to a CPT code in the fee schedule yields the unadjusted reimbursement for that procedure.

Unfortunately, the 1.5 percent conversion factor raise will not be enough to offset the nosedive some urology CPT Codes are taking in RVUs. Medicare's 2005 fee schedule indicates as much as an 81 percent reduction in office fees for certain procedures, including:

 

  •  50690 - Injection procedure for visualization of ileal conduit and/or ureteropyelography, exclusive of radiologic service (reduced 81.86 percent)
     
  •  50953 - Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation or ureteropyelography, exclusive of radiologic service; with ureteral catheterization, with or without dilation of ureter (reduced 55.57 percent)
     
  •  50955 - ... with biopsy (reduced 50.07 percent)
     
  •  50957 - ... with fulguration and/or incision, with or without biopsy (reduced 52.99 percent)
     
  •  50961 - ... with removal of foreign body or calculus (reduced 65.64 percent)

    The facility RVUs for many of these hardest-hit codes, however, changed only slightly, and increased in many cases as much as 4 percent.

    Bright side: A number of codes saw massive increases in their non-facility amounts, to the tune of nearly 800 percent. For example, 52224 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] or treatment of MINOR [less than 0.5 cm] lesion[s] with or without biopsy) will see its non-facility amount, not adjusted for geographic region, rise from $168.39 to $1,508.70.

    Also, the non-facility rate for 50021 (Drainage of perirenal or renal abscess; percutaneous) will rise from $173.99 to $955.77.

    CMS officials say they're looking into the issue of these discrepancies, but they don't believe there are any errors involved.

    Bottom line: The American Urological Association (AUA)  estimates that all changes together will cause total Medicare revenue to urologists to drop 14 percent in 2005.
     
    "However, if growth in the volume of drugs and Physician fee schedule services were to continue at the historical rates," the AUA says, "CMS projects that total Medicare revenue to urologists would decline by 8 percent."

    Note: See "Track the Biggest RVU Gainers for 2005" below for more on some of the most-affected CPT codes.

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