Urology Coding Alert

But you won't feel as much of a crunch, thanks to a budget neutrality adjustment.

CMS has released the Medicare Physician Fee Schedule for 2009. Despite a lower conversion factor, the news isn't all bleak. In fact, your urology Practice won't likely see much change in reimbursement next year. Here's what you need to know to be ready come January.

Some Specialties Fare Better Than Others

Don't lose heart when you see CMS's 2009 conversion factor of $36.066 -- a drop from 2008's $38.0870. CMS attempts to make up for the lower conversion factor by boosting the budget neutrality adjustment by 1.1 percent. Therefore, despite the lower conversion factor, the relative value units (RVUs) for some procedures have gone up.

What it means to you: While some specialties won't fare as well, urologists will see a 0 percent scheduled change to their reimbursement. Some specialties will see increases, but others will see decreases of 3 and 4 percent, so consider yourself lucky to have no change at all.

Where to find it: The specialty information, which comes from Table 48 in the Fee Schedule Final Rule, shows how the new RVU changes will affect each specialty. You can check other specialties online at http://edocket.access.gpo.gov/2008/pdf/E8-26213.pdf.

"There is a 6.5 percent, five-year practice expense reduction that has been in the works for the past five years, so without the 1.1 percent increase, we would be seeing a 6.5 percent overall decrease in reimburse-ment," says Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions. "Instead, we are now seeing a 5.4 percent decrease."

99213 Gets Boost

CMS reassigned RVU values for many procedures for 2009. While the RVUs for several procedures went down, your reimbursement for the most commonly reported code, 99213 (Office or other outpatient visit ...), rose. Whereas you currently collect $58.90 for 99213 (not including geographic adjustment), you will bring in $61.31 for this service in 2009.

Payments for 99214 (Office or other outpatient visit...) will rise from the current rate of $89.89 to $92.33 next year. Many other E/M codes will be reimbursed at higher rates in 2009 than in 2008. For example, office consultations will be paid more in 2009. Medicare paid $122.26 on 99243 in 2008, which will be reimbursed at $124.79 during 2009. Code 99244 paid $179.01 in 2008 and will be reimbursed at $184.30 in 2009. You'll see the same degree of increases 2009 for 99223 (initial hospital visit), 99253 and 99254 (hospital consultations), and 99285 (an ER visit).

Procedure changes: The fee schedule cuts fees for some procedures in the office, but increases those fees when performed in a facility. When the urologist performs the service in the office, fees for cystoscopy and bladder biopsy (52204), cystoscopy and fulguration (52214), and cystoscopy and treatment of a minor bladder lesion less than 0.5cm (52224) will fall 15 percent, 53 percent, and 28 percent respectively in 2009. In contrast, when the urologist performs these procedures in a facility, such as a hospital or ambulatory surgical center, these procedures will increase 7 percent, 18 percent, and 6 percent respectively. Remember: Reimbursements still remain significantly higher when these procedures are performed in the office, but they will be paid less in 2009 than last year.

Additionally: Payers following the Medicare fee schedule will pay you 28 percent less for code 51102 (Aspiration of bladder; with insertion of suprapubic catheter) in 2009 than in 2008 when performed in the office ($335 in 2008 to $242 in 2009), and 36 percent less in the hospital ($244 in 2008 to $157 in 2009). However, for 2009 the global period for 51102 changes from a 10-day global to a 0-day global. Therefore, remember to bill for all 51102 postoperative care administered whether in the office or hospital settings and expect full payment.

Minimally invasive procedures for the treatment of symptomatic prostatic enlargement, namely microwave thermotherapy (53850) and the green light laser or PVP (52648), will be paid 10 to 13 percent less in 2009 when performed in an office setting and 6 to 7 percent more when your urologist performs these procedures in a facility.

Look At Ways to Boost Your Income

Your practice may garner an additional 2 percent bonus if you participate successfully in the physician quality reporting initiative (PQRI) program. Another incentive next year will be that your physicians may be eligible to earn another bonus of 2 percent of their total Medicare allowed charges if they adopt an e-prescribing system.

"E-prescribing can greatly reduce the number of medication errors that jeopardize the health and safety of Medicare patients and waste precious healthcare dollars treating conditions that never should have happened," said CMS Acting Administrator Kerry Weems in an Oct. 30 statement.

Take note: You do not have to have an electronic medical record (EMR) system to perform e-prescribing, Cobuzzi says. "There are many systems that are being made available that are stand-alone e-prescription systems that are substantially less costly than a full-blown EMR."

The physician will have to register to be considered for the 2 percent bonus from e-prescribing, and must report e-prescription activity on 50 percent of the Medicare patients he sees in his office. Denominator codes will be the E/M codes 99201 to 99205, 99211 to 99215, and 99241 to 99245.

Reporting includes three G codes which indicate one of three necessary conditions: 1) G8443 says that the physician used a qualified e-prescription system for prescriptions generated during that patient encounter, 2) G8445 indicates that the physician did not write a prescription during the particular encounter although the physician has a qualified e-prescription system, or 3) G8446 says that the physician wrote or phoned in some or all prescriptions generated during the encounter due to one of the following circumstances: patient request, to comply with state or federal law, because the pharmacy's system could not receive the data electronically, because the prescription was for a narcotic or other controlled substance, or the office's qualified e-prescription system was temporarily inoperable.

Watch for Credentialing Changes, Too

The fee schedule final rule also dramatically changes how you can bill for services when you are waiting for your physician to acquire Medicare credentialing status.

Currently, you can retroactively bill the Medicare program for services that a physician rendered up to 27 months prior to the physician being enrolled to participate in the Medicare program. But in the future, that 27-month period shrinks down to a 30-day window, according to the final rule.

Take a look: To review the final fee schedule, visit the Federal Register Web site at http://edocket.access.gpo.gov/2008/pdf/E8-26213.pdf.