Urology Coding Alert

CMS finds 2 ways to raise the fees for E/M services next year

There's good news for urology practices: You'll be seeing a 1.5 percent increase in payments across the board for physician services next year, as well as significant increases in the relative value units (RVU) for several urology procedures.

Medicare has finalized the 2005 Physician Fee Schedule, with updated RVUs for many procedures, and a 1.5 percent increase in the conversion factor, which is rising to 37.8975 from the 2004 value of 37.3374. In general, Medicare multiplies the RVUs for a procedure by the conversion factor to arrive at the allowable reimbursement for a given procedure, says Sue Yourtee, business administrator for Urological Associates of Western Colorado in Grand Junction.

You will also see a net increase in the RVUs for many commonly reported evaluation and management codes. In some cases, the RVUs will decrease, but overall reimbursement will be offset by the increase in the conversion factor, as this chart demonstrates.

Watch for: Medicare adjusts fees depending on the practice's geographic location according to the relative cost of providing healthcare in that area, Yourtee says. About half of the 92 geographic areas defined by Medicare will see increases in their geographic adjustment factors (GAFs) in 2005. The rest will either not change or decrease. For example, the GAF for Santa Clara, Calif., will rise 3.4 percent, from 1.184 in 2004 to 1.224 in 2005. Meanwhile, in Manhattan, the GAF will shrink 1.8 percent, from 1.225 to 1.203.

The final fee schedule appears in the Nov. 15 Federal Register. The next issue of Urology Coding Alert will examine the changes in store for RVUs for urology procedures.