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Effect of 2009 RVU Changes on Pediatrics

Nov

19

OK, overdue, but done.  Here's what I did...I took the top 40 RVU-valid CPT codes that our clients have performed over the last 12 months and fit them into an overall model comparing the 2008 Transitioned Non-Facility Rates to the 2009 Transitioned Non-Facility rates (someone check my logic).  With the help of Siouxsie, I made sure to map things like the 99431, which doesn't exist in 2009, to the 99460, etc.

Here's the bottom line: pediatricians should expect the 2009 RVUs to reduce their average reimbursement (on those procedures) by 3.5%, not accounting for GPCI changes.  This does not address any of those non-RVU codes related to immunizations, after-hours codes, etc.  The implication of this reduction, however, is that pediatric codes will actually increase about 2.3% over last year, as Medicare will implementing an overall 5.6% cut across the board.

What are the big winners and losers this year?

CPT Code Description Difference (’08-’09)
92587 Evoked Auditory Test -43.2%
92567 Tympanometry -20.4%
95117 Immunotherapy Injections -17.1%
86580 TB Intradermal test -10.0%
99211 Office visit, est -3.8%
94760 Measure blood oxygen level +8.2%
92551 Pure tone hearing test, air +10.3%
90772 Ther/proph/diag inj, sc/im +12.5%

Tomorrow, I'll have an overdue second GPCI review, but this is the important piece today. -3.5%. Could be worse, but could be a lot better.

Thanks to Siouxse who also provided this important review of the code changes.  I need to help get this out to the world.

 

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2009 CPT Renumbering.pdf107.61 KB
Mon, 11/24/2008 - 5:43pm — branb73

  Thanks for pulling

 

Thanks for pulling that info together for us. Great stuff!

At the expense of divulging my lack of knowledge (or ignorance), could you please explain how the 3.5% 2009 RVU reduction (average reimbursement) will increase pediatric codes?

“The implication of this reduction, however, is that pediatric codes will actually increase about 2.3% over last year, as Medicare will implementing an overall 5.6% cut across the board.”

Thanks,
Brandon

 

Mon, 11/24/2008 - 5:45pm — chiphart

  Thanks for pulling

Apparently, I wrote this poorly, as you are not the only one who has asked about it. :-)

To make a long story short: the RVU “conversion factor” for Medicare
dropped 5.6% for everyone. Period. All else being equal, that’s a cut
of 5.6%. However, the individual codes themselves were changed, but at
varying levels, so depending on your particular usage of the codes (by
specialty, for example), you might receive a larger cut (-10% or more)
or even a small offsetting increase (the 2.3% for peds).

Does that make more sense?

 

Chip Hart - Pediatric Solutions
chip @ pcc.com
800-722-7708
http://pedsource.com/blog

 

Wed, 11/26/2008 - 10:29am — branb73

  Thanks for pulling

 

A little… I don’t know if I should be encouraged by the +2.3% or discouraged by the -3.5%.

If you only consider the top 40 codes, you’ll see a decrease of 3.5%.

But if you manage to increase code utilization (using the varying
levels efficiently), you may see an offsetting increase of 2.3%?

 

Wed, 11/26/2008 - 10:31am — chiphart

  Thanks for pulling

You should be encouraged by the +2.3% and discouraged by the -3.5% (really, -5+%). It’s an issue with many variables. :-)

Depending on where you live, you might be further en/dis-couraged
based on the GPCI results. For example, if you happen to practice in,
say, the greater Chicago area, you’ll see that your geographic
adjustment is also negative this year. That goes ON TOP of all this.

Let me see if I understand your question…you are asking what the
effect of doing better coding will be, vis-a-vis the changes to their
values? There’s no doubt that using better coding will help a lot, but
that’s just another variable in the mix. Note that the top 40 valid
RVUs codes (which excludes dozens of valid codes without RVUs, like
imms) represents ~95+% of the income from pediatricians, so it’s
unlikely that you will code yourself out of a decrease.

Also note that many of these changes won’t take effect immediately in a peds office - depends on your contracts.

 

 

Chip Hart - Pediatric Solutions
chip @ pcc.com
800-722-7708
http://pedsource.com/blog