Urology Coding Alert

But Congress can still change things

A few short months ago you faced the prospect of a 4.7 percent pay cut for your urology procedures in 2007--and the prognosis just got worse. If CMS' proposed fee schedule cuts go through, you will be looking at an average 5.1 percent cut next year.

CMS Offers Reasons for High Cuts

The proposed 5.1 percent decrease is the maximum amount CMS can cut your payments in one year, according to the law. The steep cut comes from skyrocketing healthcare costs--plus the fact that Congress keeps canceling annual cuts without including them in the calculation for the following year's growth rate, CMS officials say.

"Our current system is not sustainable, either from the standpoint of rising costs or quality care," CMS administrator Mark McClellan told reporters in an Aug. 8 conference call. He wants to create a new system that will save money by focusing on quality care.

Share your thoughts: You can submit comments on the proposed fee schedule reductions through the beginning of October at www.cms.hhs.gov/eRulemaking.

Prepare for Lost Payment

With the release of Medicare's proposed 2007 Fee Schedule changes, many specialties will be faced with payment decreases. Urologists face an average 5 percent cut based on three payment rulings.

Ruling 1: In a June 29 proposal, CMS estimated urologists would see a 1 percent increase in Medicare payments in 2007. This proposal came as a result of incorporating the American Urological Association's practice expense (PE) supplemental survey data, according to the AUA Capitol Update Issue 7.

Ruling 2: According to an Aug. 8 proposal, urologists face a 1 percent decrease in imaging payments next year due to changes made by Congress in the 2005 Deficit Reduction Act. This meant that the 1 percent increase and the 1 percent decrease basically offset one another.

Ruling 3: CMS announced an overall 5.1 percent proposed cut to Medicare payments. As a result, you'll be faced with a net 5.1 percent decrease if the fee schedule reduction proceeds as is.

Changes are possible: Congress could still alter the payment reduction as it has done in the past, so don't lose all hope yet.

Example: Code 52000 (Cystourethroscopy [separate procedure]) describes a procedure urologists commonly perform in the office. In Indiana, the current allowable payment for 52000 is $192.14. With a 5.1 percent cut, urologists in that state would only get $182.34. If a urologist does 300 of these a year, he would lose $2,940 in reimbursement.

See the table above for a comparison between 2006 standard, unadjusted fees, and the proposed 2007 standard, unadjusted urological fees for some frequently performed procedures (rounded to the nearest dollar).

Watch for Imaging Reductions

If your urologist performs imaging services in his office, you'll want to take note of payment changes for those procedures as well. One of the contributors to the 1 percent imaging payment reduction is the lowering of in-office physician payment for imaging services. As of Jan. 1, 2007, payment for these services will change to a lower fee whether it be the hospital outpatient department technical payment or the physician fee schedule technical component payment. The carrier will pay the urologist whichever is the lower fee.

"The AUA estimates that this change results in a $10 million loss for urology, which equates to about 0.51 percent of total urology allowed charges," the AUA stated in its AUA Capitol Update Issue 7. "The vast majority of the $10 million loss comes from a $7.6 million loss from CPT code 76942, ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation."

Good news: Medicare won't reduce a second or third imaging scan by 50 percent when it happens on a contiguous body part, as planned. Instead, CMS will keep this year's 25 percent reduction for multiple scans on the same area, thanks to data from the American College of Radiology. CMS reserves the right to increase the "discount" in future years.