Double-dose decline.

Despite some occasional small increases in the basic conversion factor (figure 1) and relative value units (RVUs) (figure 2), overall Medicare reimbursements have still not returned to 1999 levels.

Conversion factors are subject to a 10.1% reduction as a result of the 2007 budget neutrality adjustment in the work component of the RVU computation (scheduled to be 11.8% in 2008). Work comprises 46% of the RVU computation, while practice expense accounts for 50% and malpractice insurance for 4%.

Also, the amount of your individual reimbursement is subject to the adjusted geographic practice cost index (GPCI) that is calculated for each CPT and E/M code. In some cases, these GPCIs have contributed to the overall decrease in reimbursement.

Steven F. Isenberg, MD

Dr. Isenberg is an otolaryngologist in private in Indianapolis; [e-mail]

Figure 1. Chart shows recent changes in the basic conversion factor.

                2001     2002     2003      2004

Conversion      38.25   36.20     36.78     37.34
factor

Change from      --     -5.4%    +1.60% *   1.52%
previous year

                 2005     2006     2007

Conversion      37.895   37.895   37.895
factor

Change from     1.49%      0%       0%
previous year

* After March 1.

Figure 2. Chart shows recent changes in RVU for different sinus
procedures.

CPT code (sinus)     1999    2002    2003    2004    2006    2007

31255 (ethmoid)     15.26   11.59   11.46   11.69   11.80   11.37
31288 (sphenoid)    10.07    7.65    7.57    7.81    7.85    7.57
31267 (maxillary)   11.25    9.11    9.00    9.25    9.30    8.96