Q. What are the implications of the 2008 CMS & CPT changes for ED practice?
The 2008 CMS changes are a mixed bag. The good news is that the proposed 10.1% CMS 2008 pay cut has initially been voted down by Congress. President Bush signed a bill for a 0.5% pay increase effective January 1. As a result, the conversion factor increased to $38.0870. The only catch is that this payment increase runs for six months only and will end on June 30th. In absence of further congressional action, the original 10.1% pay cut will then take effect on July 1, 2008. This presents obvious challenges for ED groups in creating an annual budget.
Two important 2008 CPT changes that affect EP reimbursements are the following:
1. Infusion codes 90760 – 90761: Just when physician groups were catching on to the financial benefits of using these codes, CPT’s language change on hydration injection and infusion codes ‘makes it clear’ that these codes are not intended for physician reporting in the ED setting for 2008. (Hydration codes may still be billed for the facility, office or clinic setting.)
2. Rhythm Strip code 93042: Revised 2008 CPT language states rhythm strips are produced by a 12 lead EKG and therefore bundled or considered part of the 12 lead EKG.
Note that CMS has never reimbursed physician use for hydration therapy codes 90760 – 90761 and has also bundled rhythm strips 93042 into the EKG code. CPT and Medicare are now mirror images of each other on these codes.
For physician groups that have previously billed for hydration and/or rhythm strips, the 2008 reimbursement impact will be significant. These CPT coding changes will negatively impact your procedural frequency data, monthly charges and your financial bottom line.
If you haven’t already done so, this would be a good time to look at some of the reimbursement options such as the use of PAs or NPs, fee schedule updates and review of coding practices. Certainly for ED groups that billed rhythm strips 93042 instead of EKG 93010, it is time to reconsider the EKG issue. While EKG billing in the ED has some political implications, it would be worth the battle to pursue.
The changes and reimbursement forecast for 2008 presents a challenging road ahead. Now more than ever, it is time to pay attention to the details of thorough, complete documentation to appropriately capture all the services and related dollars you deserve!
Sharon L. Nicka, RN, CPC
President and CEO of Nicka & Associates, Inc., www.nicka-associates.com