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By: Hal Nelson, CANPC
Vice President, Anesthesiology Services
MSN Healthcare Solutions
Medicare Conversion Factors
The Anesthesia Conversion Factor is scheduled to be reduced from $21.56 to $20.71 (- 3.9%), while the Medicare Physician Fee Schedule used to price medical/surgical services, such as lines and blocks, is scheduled to be reduced from $34.60 to $33.07 (-4.4%). As happens each year, Congress will most likely reverse these projected cuts by December 31st.
Medicare Inpatient Only List
Medicare has proposed removing the following 10 procedures from the inpatient-only list in 2023. If codified within the Final Rule in November, this means that anesthesia for such surgeries will be payable in ASC settings.
- Escharotomy (CPT 16036).
- Arthrodesis (CPT 22632).
- Reconstruction midface (CPT 21141).
- Reconstruction midface (CPT 21142).
- Reconstruction midface (CPT 21143).
- Reconstruction of mandibular rami (CPT 21194).
- Reconstruction of mandibular rami (CPT 21196).
- Open treatment of nasomaxillary complex fracture (CPT 21347).
- Open treatment of fracture(s) of malar area (CPT 21366).
- Open treatment of palatal or maxillary fracture (CPT 21422).
Evaluation and Management (“Visit”) Services
The AMA and CMS have proposed to eliminate the patient History and Physical Exam components from E&M level determination for Inpatient Services, beginning January 1st.
This was previously adopted for Outpatient visits in CY 2021. The takeaway here is that patient Histories and Exams are still charted as required by the facility, they just don’t factor into coding. The level is now determined by either the Medical Decision Making or Time spent attending to patient care, whichever is more advantageous for the practice.
Chronic Pain Management
Medicare is planning to introduce new Chronic Pain Management codes, which will represent “a bundle of services” furnished per month, to Medicare beneficiaries.
Such services will include:
- Diagnosis.
- Assessment and monitoring.
- Administration of a validated pain rating scale or tool.
- The development, implementation, revision, and 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.
- Any necessary chronic pain related crisis care.
- Ongoing communication and coordination between relevant practitioners furnishing care, such as physical and occupational therapy and community-based care, as appropriate.
Colorectal Cancer Screening
Medicare is proposing to reduce the minimum age requirement for Screening Colonoscopies from 50 to 45. Since many private payors will follow suit, this will increase GI case volumes for most anesthesia practices for years to come.
Single-Dose Container or Single-Use Packaged Drugs
CMS is proposing that manufacturers provide refunds for certain discarded amounts from single-dose containers or single-use packaged drugs (threshold of > 10% of total allowed charges per drug, per quarter).
USG for Pain Blocks
The AMA has proposed bundling Ultrasound Guidance for pain blocks next year. It’s expected that the work RVUs for such blocks will be increased accordingly, to offset USG code 76942-26 becoming non-billable. Bottom line – you’ll have one less line item on your claim forms, with an increased procedural allowance.
Quality Payment Program (MIPS)
The following changes were proposed to the MIPS program in 2023:
- MIPS Value Pathways (MVPs) are a new “grouping” of measures available for anesthesia providers to report on, beginning January 1st. This eliminates the current single measure selection process. Please let your MSN client service representative know if you’re interested in participating though our QCDR.
- MIPS Data Completeness will remain at 70% in 2023 and increase to 75% in 2024/2025. This will be important for new practices using our ClearSurvey tool for measures AQI48 and ePreop30, who will want to start submitting their patient surveys on January 1st and not mid-year.
MIPS Performance Threshold will remain at 75 points (Composite Score) for 2023. This is the minimum number to avoid a penalty and receive an incentive payment.
MIPS Composite Score weighting remains unchanged in 2023: Quality – 55%, Cost – 30%, Improvement Activities – 15% (Promoting Interoperability category is not applicable to anesthesia and is reallocated to the Quality percentage).
MIPS Composite Score weighting for small practices (< 15 providers), where cost doesn’t apply: Quality – 50%, Improvement Activities – 50%.
MIPS Composite Score weighting for small practices (< 15 providers), where cost does apply: Quality – 40%, Improvement Activities – 30%, Cost – 30%.
Scoring changes include the removal of the “3-point floor”, meaning that low performance on a benchmarked measure will yield 1 or 2 points (instead of the previous minimum of 3). Also, reporting an outdated measure with no benchmark will yield zero points if it fails to receive a retroactive benchmark (i.e., less than 20 groups reported it within a given year). Reporting a non-benchmarked measure in the first or second year of its existence in the program will still earn a minimum of 7 or 5 points respectively.
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.
