Urology Coding Alert

Finally, the Centers for Medicare and Medicaid Services has published the 2003 Physician Fee Schedule and put urologists'fears about plummeting fees to rest but not all specialties are so lucky.

The 2003 fee schedule update, published in the Dec. 31, 2002, Federal Register, indicates a 4.4 percent cut in payment for all reported codes, a result of the decrease in the conversion factor, which goes into effect March 1, 2003, from $36.1992 in 2002 to $34.5920 in 2003. Claims processed prior to March 1, 2003, will be paid under the 2002 Physician Fee Schedule. Claims processed for January and February service dates after March 1, 2003, will be paid based on the 2003 fee schedule, but look for carriers to retroactively adjust claims filed between Jan. 1, 2003, and Feb. 28, 2003, to the 2003 fee schedule amount later in the year.

But the -4.4 percent update won't have the devastating impact on urologists that it will on many other physicians. Here's why: The urology codes recently went under review by the AMA's Relative Value Update Committee (RUC), and the resulting adjustments have offset the loss of revenue that would have occurred due to the -4.4 percent update, says Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC in Indianapolis. "The result of the recent payment adjustments is a 2 percent overall improvement for urology-code RVUs."

For example, 52000 (Cystourethroscopy [separate procedure]) has a total non-facility RVU of 7.35. Multiplied by the conversion factor for 2003, $34.5920, this means that the national Medicare payment (without a geographical adjustment) for a cysto performed in the nonfacility setting is $254.25, an increase of more than $50 from the national fee of $201.99 in 2002.

According to Michele A. Wrightson, CCS-P, CPC, coding specialist for UMMHH Department of Surgery in Worcester, Mass., the fee schedule increase for 52000 won't make much of a difference. "Procedure code 52000 is bundled in most of the procedures" performed by many urology surgeons, she says. "Therefore, it isn't billed as frequently and won't make a significant difference in our collected fees."

"In general, with the lowering of the conversion factor and decreases in work RVUs, the average urology practice can anticipate an overall 3-4 percent decrease in gross revenues for FY2003," says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook.

Urologists can also welcome the correction of a previous urology service anomaly. CMS addressed concerns generated by the water-induced thermotherapy (WIT)equipment manufacturer about the estimated practice expense inputs for 53853 (Transurethral destruction of prostate tissue; by water-induced thermotherapy) as compared to two other codes for transurethral destruction of prostate tissue, 53850 ( by microwave thermotherapy) and 53852 ( by radiofrequency thermotherapy). After comparing the WIT procedure to the other codes for transurethral destruction of prostate tissue, CMS decided the manufacturer was correct in its determination that the WIT procedure was undervalued.

The result: CMS will increase the price for the thermotherapy equipment to $80,000 on an interim basis and will initiate a practice-expense refinement process in an effort to include the proposed pricing revisions to the inputs in 2004's proposed rule.

Three bladder lesion TUR/fulguration codes that were mistakenly identified as subject to the multiple-procedures reduction rather than the endoscopic-services reduction in the Medicare Physician Fee Schedule Database have been correctly identified as codes subject to the procedural-reduction rules for endoscopic services.

Prior to the correction, cystoscopy and treatment CPT codes 52234, 52235 and 52240 were overpaid as secondary endoscopic codes, an anomaly corrected by the 2003 endoscopic-reduction rules, which identify CPT code 52000 (Cystourethroscopy [separate procedure]) as the endoscopic base for the three codes. In other words, when you report 52234, 52235 and/or 52240, the fee for 52000 will be automatically subtracted from the applicable code, Hause explains.

So if you were to bill 52235 as a secondary procedure, and the primary procedure was also an endoscopic procedure such as 52318 (Litholapaxy; complicated or large [over 2.5 cm]), the fee for 52000 would be subtracted from the fee for 52234 and the result would subsequently be reduced 50 percent to reach the actual reimbursement, he adds. "By the use of this method, Medicare only pays for the surgical approach one time on the claim."

With respect to the above three codes, CMS has issued three rules for reporting the treatment of multiple bladder tumors: