January 6, 2006

NYSRS HEALTH INSURANCE, COMPENSATION & CAC REPORT 

MEDICARE UPDATE

The ‘Stark’ Reality*:

“A prohibition limiting doctors from referring patients to nuclear imaging centers in which they have a financial stake is delayed until 2007.”

         (Part B News, Volume 19, No. 43, November 7, 2005, p. 8)

Projected Impact of 2006 CMS RVU Changes*:

Radiation Oncology ---- NEGATIVE 5%

Radiology -----------------NEGATIVE 6%

         (Part B News, Volume 19, No. 43, November 7, 2005, p. 9)

“The dip in pay is due in large part to a reduction in the conversion factor (CF)—which, unless Congress intervenes and enacts legislation altering the rate, has been set at $36.1770.  Compared to this year’s $37.8975, this reflects a 4.5% cut, including a 4.4% negative update and other reductions.”  Examples include:

Code          Exam                            2005 Payment               2006 Payment

71010         Single View Chest        $28.04                          $26.77

72197         MRI pelvis w/wo        $117.48                        $112.14

74170         CT abdomen w/wo       $72.76                          $69.45

74240         Upper GI Series           $36.00                          $34.36

76092         Bilateral Screening       $36.38                          $34.72

                   Mammo

                            (Radiology Coder’s Pink Sheet, Vol. 4, No. 12, Dec 2005, p. 6)

“Payment for the technical component of certain radiology services will be reduced by 25% next year--- a pay cut, but less than the 50% reduction originally proposed by CMS . . . “  . . . “For now, the 50 % cut in reimbursement for the technical component of these services will go into effect in 2007.” . . . “The payment reduction applies to the technical component of the service only.” . . .  Examples of decreases in reimbursement include: 76856 (ultrasound, complete pelvis) –11.6%; CT pelvis (w/o & w/ contrast) –13.5%; CTA of neck or CT head/brain (w/o & w/ contrast) – 12.3%; MRI abdomen w contrast –13.8%; CT of cervical or lumbar spine (w/o contrast) – 14.0%.

         (Part B News, Volume 19, No. 43, November 14, 2005, p. 3-4)

CMS Payment for LOCM*:

“On Jan. 1, 2005, CMS eliminated the five patient conditions it required for you to bill for LOCM for non-hospital patients.” . . . “On April 1, 2005, CMS replaced the old HCPCS codes for LOCM (A4644-A4646) with Q9945-Q9951. . . “  “CMS based payment for LOCM on the average sales price plus 6%.”  See article to view payment table:

         (Part B News, Volume 19, No. 45, November 21, 2005, p. 7)

Two Year Demonstration Project RE: Chiroprators Ordering X-rays, MRI’s, & CT*:

This Demonstration Project, in Maine, New Mexico and parts of Iowa, Illinois & Virginia, is intended to “determine just how much Medicare should expand payment for chiropractic services.  (The Coding Institute. Special Issue, October 2005, p.74)

Article in Part B News, October 31, 2005, Volume 19, No. 42, pp. 5-6

Headline*:  “Non-radiologists’ win skirmish in turf war over imaging.” ---- “An attempt to curtail ‘non-radiologists’ ability to perform certain diagnostic tests in the office was recently thwarted, according to lobbyists and the American Medical Group Assn.” . . . . . . “There appears to be no let-up in the turf war over diagnostic imaging.” . . . .  Many specialty societies who oppose physician ‘credentialing’ for diagnostic imaging say there is no evidence that the rise in utilization of diagnostic imaging is due to ‘inappropriate’ tests.”

Kyphoplasty Codes to Change in 2006*:

“The addition of three codes specific to kyphoplasty . . .” are anticipated in 2006.  These are: 22523 - “Percutaneous vertebra augmentation, including cavity creation (fracture reduction

and bone biopsy included when performed) using mechanical device, one vertebral body, unilateral or bilateral cannulation (eg, kyphoplasty); thoracic “

22524 ----- lumbar

22525 ----- “each additional thoracic or lumbar vertebral body . . . “

See article for additional details: 

         (Radiology Coder’s Pink Sheet, Vol. 4, No. 11, Nov 2005, p. 1)

         (Radiology Coding Alert, Vol. 7, No. 12, Dec 2005, p. 92)

CPT Replaces 2D Postprocessing Codes with 2 New 3-D Only Codes*:

“CPT 2006 includes two new codes that specify the rendering must be 3D, unlike 76375, which said rendering could be 2D, 3D, or holographic.”  The new codes that will replace 76375 are:

         76376 – 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality; not requiring image postprocessing  on an independent workstation.

         76377 – requiring  image postprocessing on an independent workstation..

                   (Radiology Coding Alert, Vol. 7, No. 12, Dec 2005, p. 89)

*For more detailed information, recommend review of the source information, cited above.

Home Page Information:

http://www.ghimedicare.com/

http://www.umd.nycpic.com/

http://www.gao.gov

Coding 

Upstate Medicare - http://www.umd.nycpic.com/billtips.html#ICD-9-CM  and then select, ICD-9-CM Coding for Diagnostic Tests

Respectfully submitted,

Arthur J. Segal, M.D., F.A.C.R.

Chairman, Medical Insurance and Compensation Committee / NYSRS CAC Representative