Proposed 2010 Physician Fee Schedule: A Closer Look

Posted on 15. Jul, 2009 by Editor in Provider News

21.5 percent cut looms for your services

Last week, Coding News outlined highlights of the proposed Medicare Physician Fee Schedule, printed in the July 13 Federal Register. Today, we’ll look more closely at some of the black holes–such as the reimbursement hit practices will take when they must charge E/M visits instead of consults. But we won’t ignore shining little lights such as a payment boost for the ‘Welcome to Medicare’ exam.

CMS is projecting a record 21.5 percent rate cut, and proposes halting payment for consult codes in 2010. Instead of reporting consult codes, you’d report new or established patient office visit or hospital care (E/M) codes for these services, and CMS would increase payments for the existing E/M codes.

To determine the impact of this change, you’d have to compare the reimbursement from the new fee schedule office visit fees vs. the current office consult fees, as well as the new hospital visit E/M charges vs. the current hospital consult fees, says Quinten A. Buechner, MS, MDiv, CPC, ACS-FP/GI/PEDS, PCS, CCP, CMSCS, president of ProActive Consultants in Cumberland, Wis.

Using this year’s figures, you’d lose between $16 to $45 for office consults that would now be coded as new patient visits, and you’d lose $30 to $100 for established office consults coded as E/Ms, Buechner says. A rough calculation shows that the additional E/M payments (proposed at 6 to 8 percent) may not cover the loss of consult money. This could cause pay cuts for specialists in particular, who bill consults more often than primary care physicians.

AUDIO: Do you use the 1995 E/M Guidelines? Then don’t miss the 4×4 rule.

Potential good news: Whether or not the pay cuts will actually become final is anyone’s guess. “Since far less...

Tags: CMS, consultations, consults, conversion factor, e-prescribe, E/M, G0402, IPPE, Medicare Physician Fee Schedule, RVU, Welcome to Medicare