LESS reimbursement

[jonnylingo]

Once again, salary taking a hit. Is anyone else seeing private insurance groups not allowing consult codes 99244, 99243 etc? There's a large private insurance group with whom my clinic contrats who is following Medicare's suit and not accepting consults. Now it's all "new pt" codes 99204, etc.

For me, that's .72 RVU difference for a level 4, so in dollar amounts that's $37.44 less for initial eval. Going to have to make this up somehow. More patients, less time.

Anyone else feeling the squeeze? Is this the way of the future?

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[RUOkie]

Once again, salary taking a hit. Is anyone else seeing private insurance groups not allowing consult codes 99244, 99243 etc? There's a large private insurance group with whom my clinic contrats who is following Medicare's suit and not accepting consults. Now it's all "new pt" codes 99204, etc.

For me, that's .72 RVU difference for a level 4, so in dollar amounts that's $37.44 less for initial eval. Going to have to make this up somehow. More patients, less time.

Anyone else feeling the squeeze? Is this the way of the future?

I haven't used a consult code in 2 yrs. I took it off my superbill so I would not be tempted. Every insurer around here followed suit within 6 months of CMS's action.

 

[maw4bc]

Once again, salary taking a hit. Is anyone else seeing private insurance groups not allowing consult codes 99244, 99243 etc? There's a large private insurance group with whom my clinic contrats who is following Medicare's suit and not accepting consults. Now it's all "new pt" codes 99204, etc.

For me, that's .72 RVU difference for a level 4, so in dollar amounts that's $37.44 less for initial eval. Going to have to make this up somehow. More patients, less time.

Anyone else feeling the squeeze? Is this the way of the future?

You think .72 RVU difference is bad. Get a load of these numbers:

http://www.aan.com/go/practice/coding

With this change coming Jan 1, 2013, a standard CTS would be making 65% less per patient, or $425. That is an astronomical decrease in NCS reimbursement.

I really hope AAN & AANEM & AAPMR can team together to stop this from happening.

 

[jonnylingo]

You think .72 RVU difference is bad. Get a load of these numbers:

http://www.aan.com/go/practice/coding

With this change coming Jan 1, 2013, a standard CTS would be making 65% less per patient, or $425. That is an astronomical decrease in NCS reimbursement.

I really hope AAN & AANEM & AAPMR can team together to stop this from happening.

This is just madness. The squeeze is on. Soon, no one in their right mind will choose medicine (MD/DO route), it will simply be impossible to pay back loans and meet RVU benchmarks without running a mill. What is the solution? I mean, looking at these numbers for EMG/NCS, and looking at the slashed consult codes, we will have to see 1/4 - 1/3 more patients just to BREAK EVEN with RVU goals of yesteryear. Any other group would strike. Since this seems to be impossible, are we to just bend over and take it? Just venting here. But I'm open to any thoughts on this insanity.

 

[Paddington]

In all honesty though, consults were a joke. I never understood why it should pay better for doing the same work (or as I experienced during my internship, a lot less work), just because they were referred to you vs. referring themselves.

 

[maw4bc]

This is just madness. The squeeze is on. Soon, no one in their right mind will choose medicine (MD/DO route), it will simply be impossible to pay back loans and meet RVU benchmarks without running a mill. What is the solution? I mean, looking at these numbers for EMG/NCS, and looking at the slashed consult codes, we will have to see 1/4 - 1/3 more patients just to BREAK EVEN with RVU goals of yesteryear. Any other group would strike. Since this seems to be impossible, are we to just bend over and take it? Just venting here. But I'm open to any thoughts on this insanity.

Worst part about it is that they made brand new billing codes for NCS, so private insurances are going to HAVE to put some kind of value with those new codes by Jan 1. Obviously they will be closer to what Medicare has. So they are giving us a <2 month heads up on a 65% decrease for the only thing in my office that keeps my margins in the black. They have slowly decreased every other aspect of Neurology and then they pop this on us.

 

[Finally M3]

At the same time, this is payback for all those folks doing a 3-limb EMG/NCS on a unilateral CTS. Or an EMG on every single radiculopathy that walks into their office.

Yes, this will hurt my pocket quite a bit...but AANEM members need to look in the mirror a little bit as well.

 

[bedrock]

With this change coming Jan 1, 2013, a standard CTS would be making 65% less per patient, or $425. That is an astronomical decrease in NCS reimbursement.

I really hope AAN & AANEM & AAPMR can team together to stop this from happening.

It's too late. When they started the bundling the codes last fall, I knew we were only one year away from a major drop in EMG reimbursement, and I started to shift some EMG referral patterns out of my practice.

This is why I do US-guided peripheral procedures, fluoro-guided spine procedures, and EMGs. Good to have more than one option to pay the bills.

I feel bad for docs who really depend on EMGs to balance their books.

 

[bedrock]

I haven't used a consult code in 2 yrs. I took it off my superbill so I would not be tempted. Every insurer around here followed suit within 6 months of CMS's action.

Weird. Half of my local commercial insurers still pay consult codes, (East Coast) and I make plenty of money off consult codes as I still bill those on every insurance that still pays them.

 

[RUOkie]

At the same time, this is payback for all those folks doing a 3-limb EMG/NCS on a unilateral CTS. Or an EMG on every single radiculopathy that walks into their office.

Yes, this will hurt my pocket quite a bit...but AANEM members need to look in the mirror a little bit as well.

I agree with you. Lots of questionable studies done.

It's too late. When they started the bundling the codes last fall, I knew we were only one year away from a major drop in EMG reimbursement, and I started to shift some EMG referral patterns out of my practice.

This is why I do US-guided peripheral procedures, fluoro-guided spine procedures, and EMGs. Good to have more than one option to pay the bills.

I feel bad for docs who really depend on EMGs to balance their books.

I am the same way, but just substitute Workers comp/Occ med for fluoro spine.

 

[PMR2008]

So now that the NCV and EMG cuts are pretty much confirmed I was wondering how this will effect your practice?

 

[MedBronc23]

Also glad will have US and Fluoro experience coming out residency and or fellowship. I was not planning on doing a ton of EMGs but this new decrease in reimbursement is making that more of a reality. Probably just use if a private ortho group practice wants me to do theirs as part of my practice.

I hope AAPMR fight it.

 

[RUOkie]

So now that the NCV and EMG cuts are pretty much confirmed I was wondering how this will effect your practice?

I will no longer do multiple limb studies unless I am specifically looking for neuropathies or motor neuron disease.

For example: If a patient is referred to me for Lumbar radiculopathy/CTS. I will do the studies on different days (since the RVUs were lowered most for the larger studies). I will also book less time for EDX studies.

No more Consults/EMGs. Consult first, return for the study. Even if for different problems.

I have a broad practice with US/ lots of E&M/ EMG/ some inpatient.

DESPITE THE CUTS, EMG/NCS IS STILL THE BEST REIMBURSED PROCEDURE IN MY OFFICE!!

Finally, I will make less money.

 

[bedrock]

I have a broad practice with US/ lots of E&M/ EMG/ some inpatient.

DESPITE THE CUTS, EMG/NCS IS STILL THE BEST REIMBURSED PROCEDURE IN MY OFFICE!!

.

EMG reimbursed better than US in 2013? You must not do many US injections or are quite slow with US injections.

 

[RUOkie]

EMG reimbursed better than US in 2013? You must not do many US injections or are quite slow with US injections.

I schedule 20-30 min for an injection. 30min for a single extremity EMG. So I guess I am slow with injections. And quick for EDX. More experience and all.

Also, Check your fee schedules for your private health insurers and Work Comp. My billing company called lots of insurers this past week to discover that they have NOT updated their systems to the new codes and told them (to tell us) to use the 2012 codes. I am only using the new codes for Medicare.

 

[bedrock]

I schedule 20-30 min for an injection. 30min for a single extremity EMG. So I guess I am slow with injections. And quick for EDX. More experience and all.

Sounds about right for the EMG, but much too slow for an US guided injection. It depends somewhat on the range of what you inject, but no single injection should take more than 15 minutes of your time, and many require 5 minutes or less.

Need to train your staff better to prep the machine, patient, injection materials, etc, so the physician isn't wasting their time. That's when US pays well, and better than EMG (even 5 years ago).

 

[RUOkie]

Sounds about right for the EMG, but much too slow for an US guided injection. It depends somewhat on the range of what you inject, but no single injection should take more than 15 minutes of your time, and many require 5 minutes or less.

Need to train your staff better to prep the machine, patient, injection materials, etc, so the physician isn't wasting their time. That's when US pays well, and better than EMG (even 5 years ago).

yeah, well I have one staff member. Yes, that is correct. I run a bare bones practice. I'm not going to hire more staff to increase my efficiency by 10-15%. Just not going to happen. I'm still pretty happy with how my practice runs. I just acknowledge that I'm slow with some stuff.

 

[jsaul]

can anyone tell me exactly what the medicare reimbursement for the new emg/ncv codes are?

for example 95908, 95909, 95910
and emg 95886

 

[bkpa2med]

Google cms physician fee schedule lookup

 

[lobelsteve]

can anyone tell me exactly what the medicare reimbursement for the new emg/ncv codes are?

for example 95908, 95909, 95910
and emg 95886

95908, 95909, 95910 : You owe CMS $45 per limb to perform the study
and emg 95886: $15.99 per limb and free salad bar.