With the OIG’s publication of the Final Rule earlier this month, CMS codified Medicare’s Physician Fee Schedule changes which will affect anesthesia practices, beginning the first of the year. Listed below is a summary of each relevant change.
Medicare Anesthesia Conversion Factor
The national anesthesia conversion factor was reduced from $21.5623 to $20.6097 (-4.4%). This is the unit rate which is used to pay anesthesia “time-based” services. State locality variances apply.
Medicare Medical/Surgical Conversion Factor
The national medical/surgical conversion factor was reduced from $34.6062 to $33.0607 (-4.4%). This is the rate used to calculate allowable amounts for services such as lines, blocks and pain rounds. State locality variances apply.
Evaluation and Management (E/M) Visits
The AMA and CMS revised the code selection criteria for inpatient visits to include either the “Medical Decision Making” category or documented time, whichever is more advantageous to the practitioner. This allows for higher level E\M codes to be potentially billed, when time spent attending to a patient exceeds the norm (this change mirrors a modification made to outpatient E/M visits by CMS in 2021). Although this will have little impact to anesthesia-related services such as pain rounding, it’s definitely helped to simplify visit coding for chronic pain management services. Essentially, History and Exam are no longer factored into E/M level determination and are simply charted for medicolegal purposes.
Split or Shared Visits
CMS clarified that split or shared E/M visits can continue to be billed under the provider with the “substantive portion” of the visit, until CY 2024.
Chronic Pain Management and Treatment Services
CMS finalized new HCPCS codes G3002 and G3003 for chronic pain management and treatment services to Medicare beneficiaries.
The new codes include a bundle of services furnished during a given month, including:
- Assessment and monitoring
- Administration of a validated pain rating scale
- Development, implementation, revision, and/or maintenance of a person-centered care plan that includes strengths, goals, clinical needs and desired outcomes
- Overall treatment management
- Facilitation and coordination of any necessary behavioral health treatment
- Medication management
- Pain and health literacy counseling
- Necessary chronic pain related crisis care
- Ongoing communication and coordination between relevant practitioners furnishing care, such as physical and occupational therapy, complementary and integrative care approaches, and community-based care, as appropriate.
Colorectal Cancer Screening
As anticipated, CMS reduced the minimum age requirement for screening colonoscopies from 50 to 45, in alignment with recent United States Preventive Services Task Force and professional society recommendations. This will result in higher GI case volumes for anesthesia practices.
Changes to CMS Inpatient Only List
As published in the CMS Hospital Outpatient and Ambulatory Surgical Center Payment Systems Final Rule, the following 10 surgical procedures were removed from the Medicare Inpatient Only (IPO) list. This means that these procedures (and their corresponding anesthetics) are now eligible for payment consideration in ASC settings:
- 16036 (Escharotomy)
- 22632 (Arthrodesis, posterior interbody technique)
- 21141 (Reconstruction midface)
- 21142 (Reconstruction midface)
- 21143 (Reconstruction midface)
- 21194 (Reconstruction of mandibular rami)
- 21196 (Reconstruction of mandibular rami)
- 21347 (Open treatment of nasomaxillary complex fracture)
- 21366 (Open treatment of complicated fracture of malar area)
- 21422 (Open treatment of palatal or maxillary fracture)
Ultrasound Guidance for Post-Op Pain Blocks
The AMA/CPT revised the descriptor for the following post-op pain blocks, which now include ultrasound guidance (USG). Therefore, it will not be appropriate to bill USG code 76942-26 with these blocks, beginning with 1/1/23 dates of service. The rationale for this change is that ultrasound guidance has become the “standard of care” in performing these procedures. For reference, the Medicare national allowance for this service was $31.14, in CY 2022.
- 64415 Brachial Plexus; single stick
- 64416 Brachial Plexus; continuous
- 64417 Axillary Nerve; single stick
- 64445 Sciatic Nerve; single stick
- 64446 Sciatic Nerve; continuous
- 64447 Femoral Nerve; single stick
- 64448 Femoral Nerve; continuous
Hal has 30+ years of experience on both the payor and RCM side, with a focus in Anesthesia. He formerly worked as a senior claims approver at United Healthcare, as well as a compliance officer for multiple national anesthesia billing companies. His broad-based experience ensures that MSN clients have a resource for documentation and billing issues. His past speaking engagements include ASA, MGMA, Dartmouth, and Johns Hopkins.
This educational guide was prepared as a tool to provide education for documentation and coding. It is not intended to affect clinical treatment patterns. The material provided is for informational purposes only. Efforts have been made to ensure the information within this document was accurate on the date of distribution. Reimbursement policies vary from insurer to insurer and the policies of the same payer may vary within different U.S. regions. All policies should be verified to ensure compliance. CPT® codes, descriptions and other data are copyright of the American Medical Association (or such other date of publication of CPT®).All Rights Reserved. CPT® is a registered trademark of the American Medical Association. Proprietary and confidential document. All rights reserved. No part of this document may be reproduced or used in any manner without the written permission of MSN Healthcare Solutions, LLC.