The AANEM staff has been studying the electrodiagnostic (EDX) medicine relative value units (RVUs) since CMS announced them November 1. While most EMG RVUs have increased, the nerve conduction study (NCS) RVUs have decreased significantly—as much as 50-68% for standard procedures—due primarily to cuts in the practice expense values. The combined effect of performing NCSs and needle EMG in standard procedures will result in reimbursement decreases of 31-69% in 2013. The reimbursement decrease averages 48% across standard procedures.
“AANEM staff and board recognize the impact these reductions will have on our members and the patients they care for,” stated Shirlyn Adkins, JD, AANEM executive director. “We are working with the AAN and AAPMR to urge CMS to reduce these cuts which will impact patient care and are developing resources for our members to help you understand the impact on your practice.”
The AANEM has created a table
that demonstrates the total RVU impact using AANEM’s recommended practice guidelines. We have developed a 2013 coding toolkit—available to members at www.aanem.org/2013changes
—that includes a calculator where you can compute the impact to your practice and a crosswalk for 2012-2013 code changes. In addition, we will be hosting a webinar detailing the coding changes with Andrea Boon, MD, physician liaison to the RVU Committee, and Catherine French, MAPL, AANEM health policy director. Visit the Marketplace
to sign up. Limited space is available.
“We’ll update the toolkit as more information is known,” said Catherine French, MAPL, AANEM health policy director. “We also welcome your questions, as we will use them to create and update a Frequently Asked Questions section in our toolkit.” Questions should be submitted using the web form
AANEM also is working with the American Academy of Neurology (AAN) and the American Academy of Physical Medicine & Rehabilitation (AAPMR) to communicate the RVU impact to CMS. “We have submitted a request to meet with CMS in early December to share the serious and potentially damaging impact of these changes to those providing EDX care and those being served by EDX physicians,” Adkins added.
The association also has been in touch with patient groups and our legal representatives to determine next steps in appealing the CMS decision.
CMS indicated that the EMG and NCS code reductions were part of its “misvalued codes initiative.” In 2006, the Medicare Payment Advisory Commission (MedPAC) reported to Congress that “misvalued services can distort the price signals for physicians' services...” Since then, CMS and the AMA RUC have increased efforts to identify potentially misvalued services in several categories. The EDX codes were reviewed because they are reported together at least 75% of the time.
“We believe CMS determined that practice expenses for NCSs were overpaid previously, because each NCS received the same level of practice expense and multiple units of NCSs were billed per patient on the same day,” noted French. AANEM is reviewing the practice expense calculations used by CMS.
The AANEM will continue to send e-news updates as we move forward with our appeal process and as we add items to our coding toolkit.