There is good news for 2004 for physicians in regard to Medicare compensation. Effective January 1, 2004, physicians can expect to receive a 1.5% increase in their Medicare payments as opposed to the 4.5% decrease that had been proposed for 2004. In addition, as part of the Medicare Prescription Drug, Improvement and Modernization Act, physicians practicing in rural areas can expect to receive up to a 4.8% increase.
| Procedure |
2003 |
2004 |
| 88141 |
22.21 |
22.39 |
| 88304 |
40.30 |
39.96 |
| 88304-26 |
11.82 |
12.10 |
| 88305 |
90.48 |
91.50 |
| 88305-26 |
39.77 |
40.71 |
| 88307 |
156.11 |
157.46 |
| 88307-26 |
84.55 |
86.21 |
| 99283 |
59.00 |
60.84 |
| 99284 |
92.11 |
94.43 |
| 99285 |
143.60 |
147.93 |
| 99203 |
89.72 |
93.47 |
| 99203 (facility setting) |
68.53 |
70.56 |
| 99204 |
127.95 |
132.23 |
| 99204 (facility setting) |
101.21 |
104.03 |
| 99205 |
163.42 |
168.19 |
| 99205 (facility setting) |
134.25 |
138.23 |
| 99213 |
49.37 |
51.13 |
| 99213 (facility setting) |
33.74 |
34.92 |
| 99214 |
77.15 |
79.89 |
| 99214 (facility setting) |
55.28 |
56.98 |
| 99215 |
113.33 |
116.21 |
| 99215 (facility setting) |
89.02 |
91.89 |
For your reference, I have noted in this table the Ohio reimbursements for 2003 and 2004 on a few of the common procedure codes that we see in the Managed Accounts Receivable Area.
Pathology CCI Edits
Effective October 1, 2003, CMS implemented Correct Coding Initiative edits on a few of the pathology codes.
The first edit is on codes 88160, 88161 and 88162 and prohibits the use of these codes with the surgical pathology codes 88304 to 88309. The CCI edit will allow the use of the 59 modifier to bypass the denial if the cytopathology smears are performed on separate specimens and independent diagnoses are rendered.
The second edit, prohibits the use of the flow cytometry code of 88180 with cytopathology codes 88108, 88160, 88161 and 88162. Again, the use of the 59 modifier is permitted if the cytopathology service is performed for diagnostic purposes that are unrelated to the flow cytometry test.
For services performed October 1, 2003, we are receiving CCI edit denials from Medicare on the code sequences noted above. The Field Service Representatives have notified our pathology practices and advised them that it is best to submit the 59 modifier in the initial submission of charge data to avoid inappropriate denials and appeals. CCI adjustments will be taken on the denied procedures if we are unable to verify that the denied services are separately and uniquely identifiable. |
