Anesthesia Coding Alert

Get quick tips on Part B drug modifier JZ, chronic pain management code G3002, and more.

The 2023 Medicare Physician Fee Schedule (MPFS) final rule brought ups and downs for anesthesiologists and pain management specialists. Let’s jump in to discover six of the areas you need to know for your specialty.

1. See How Much Lower Final Conversion Factors Are

The MPFS proposed rule indicated providers could expect the MPFS conversion factor (CF) and anesthesia conversion factor (ACF) to be lower in 2023 than in 2022. But the final rule brought even lower CFs than the proposed rule.

The proposed rule estimated the ACF would be $20.7191. However, “the 2023 finalized [ACF] is $20.6097, representing a decrease of 4.42% from the 2022 ACF of $21.5623,” stated the American Society of Anesthesiologists (ASA) in a news release (www.asahq.org/about-asa/newsroom/news-releases/2022/11/final-2023-medicare-physician-payment-rule). Additionally, the 2023 finalized MPFS CF “is $33.0607, representing a decrease of 4.47% from the 2022 RBRVS of $34.6062,” according to the ASA news release.

“While the final rule CF is slightly different from the proposed CF, the biggest concern is the overall decrease in payments,” says Carol Pohlig, BSN, RN, CPC, manager of coding and education in the department of medicine at the Hospital of the University of Pennsylvania in Philadelphia. Congress could intervene to adjust the CF, as they did in 2021 at the last minute, but this has not occurred as of publication time. “ASA has urged and will continue to advocate to Congress and regulatory agencies to minimize and reverse these cuts that negatively impact anesthesiologists and the care they provide to the important Medicare patient population,” said ASA president Michael W. Champeau, MD, FASA, in the news release.

More, the 3 percent supplemental payment increase in 2021 practices were granted was set to expire at the end of 2022, so practices have been anticipating lower reimbursement for 2023. Table 148 of the MPFS final rule shows an estimated impact of -2 percent on anesthesia total allowed charges.

2. Watch for Guidance on Colorectal Cancer Screening Coverage

Medicare will expand colorectal cancer (CRC) screening coverage by reducing the minimum age for certain tests from 50 to 45 years of age, the final rule states. Screening colonoscopies will continue to not have a minimum age limitation.

The final rule also states Medicare will “expand coverage of CRC screening tests to include a follow-on screening colonoscopy after a noninvasive stool-based test returns a positive result.”

Why it matters: The change means beneficiary cost sharing for both the initial noninvasive screening stool-based test and the follow-on screening colonoscopy test typically will not apply because both tests will be paid at 100 percent as preventive screenings, as noted in “Did You Catch This Colonoscopy Change in the MPFS 2023 Proposed Rule?” in Anesthesia Coding Alert, Volume 24, Number 11.

Look out: The final rule indicates Medicare will provide instructions on coding and payment through transmittals and MLN Matters articles. Unfortunately, Medicare opted not to respond to comments about recommendations on anesthesia service coverage in this section on CRC screening, but Medicare “will take them into consideration for possible future rulemaking,” the final rule states.

3. Focus on 5 MIPS Measures in the Anesthesiology Specialty Set

The MPFS final rule also finalizes the anesthesiology specialty measure sets for the 2023 performance period and the2025 Merit-based Incentive Payment System (MIPS) payment year. You can go straight to this table at www.federalregister.gov/d/2022-23873/page-70282.

Here are the previously finalized measures in the anesthesiology specialty set:

• 404: Anesthesia Smoking Abstinence
• 424: Perioperative Temperature Management
• 430: Prevention of Post-Operative Nausea and Vomiting (PONV) — Combination Therapy
• 463: Prevention of Post-Operative Vomiting (POV) — Combination Therapy (Pediatrics)
• 477: Multimodal Pain Management

One measure not finalized for addition to the anesthesiology specialty set was 487: Screening for Social Drivers of Health. While Medicare wants anesthesiologists to assess this topic in their population, the agency doesn’t want to make it mandatory. As you can see in the bullet list above, the anesthesia specialty set has five measures. “For specialty sets that contain six or less MIPS quality measures, individual MIPS eligible clinicians, groups, and virtual groups must report on all MIPS quality measures within the specialty set. In the case of the Anesthesiology Specialty Set, this measure would thus inadvertently become mandatory to report,” the MPFS final rule states in explaining why the measure was not finalized for anesthesia.

Measure 076: Prevention of Central Venous Catheter (CVC)-Related Bloodstream Infections was finalized for removal from the anesthesiology specialty set because it was a topped-out measure, meaning one where performance is so high and unchanging that meaningful benchmarks and improvement can’t be made.

4. Modifier JZ Joins JW for Part B Drugs

If your practice supplies and reports the drugs administered to patients, you should be familiar with using modifier JW (Drug amount discarded/not administered to any patient) when the provider administers part of a single-dose container and discards the rest. Reporting the discarded amount with modifier JW allows you to receive payment from Medicare Part B for the portion not administered.

The MPFS final rule states that starting July 1, 2023, you will need to use a new, related modifier when there are no discarded amounts from a single-dose container subject to modifier JW rules. The new modifier is JZ (Zero drug amount discarded/not administered to any patient). The modifier has an effective date of Jan. 1, 2023, but Medicare opted to give providers until July 1 to start using JZ. Claims processing edits will begin Oct. 1, 2023, with Medicare checking use of both JW and JZ.

Tip: You will use modifier JZ on the claim line with the administered amount.

5. Apply G3002 and +G3003 for Chronic Pain Management

For 2023, Medicare is adding two codes for chronic pain management and treatment:

• G3002 (Chronic pain management and treatment, monthly bundle including, diagnosis; assessment and monitoring; administration of a validated pain rating scale or tool; the 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; any necessary chronic pain related crisis care; and ongoing communication and care coordination between relevant practitioners furnishing care, e.g. physical therapy and occupational therapy, complementary and integrative approaches, and community-based care, as appropriate. Required initial face-to-face visit at least 30 minutes provided by a physician or other qualified health professional; first 30 minutes personally provided by physician or other qualified health care professional, per calendar month. (When using G3002, 30 minutes must be met or exceeded.))
• +G3003 (Each additional 15 minutes of chronic pain management and treatment by a physician or other qualified health care professional, per calendar month. (List separately in addition to code for G3002. When using G3003, 15 minutes must be met or exceeded.))

For these codes, Medicare defines “chronic pain as persistent or recurrent pain lasting longer than 3 months,” the final rule states. Expect to see a work RVU of 1.45 for G3002 and a work RVU of 0.5 for +G3003.

Watch for a future article in Anesthesia Coding Alert providing more information about these codes. You can see what the MPFS final rule has to say about them by heading to www.federalregister.gov/d/2022-23873/page-69524 and scrolling down to the header “(33) Chronic Pain Management and Treatment (CPM) Bundles (HCPCS G3002 and G3003, Formerly GYYY1 and GYYY2, Respectively).”

6. Size Up RV Us for Somatic Nerve Injections

CPT^® 2023 added “including imaging guidance, when performed” to the descriptors for somatic nerve injection codes 64415-64417 and 64445-64448. That means you should no longer report ultrasound (such as 76942, Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation) or other types of imaging guidance separately along with those injections. Anesthesia practices often use these injections for postoperative pain management.

The MPFS proposed rule indicated you could expect a reduction to the total work RVUs for the injections plus ultrasound guidance in 2023. (See “Change Your Post-Op Pain Management Reporting in 2023” in Anesthesia Coding Alert, Volume 24, Number 10.) Below you can see how the 2023 proposed and final rule RVUs compare to 2022. While all of the 2023 work RVUs will be lower than 2022, Medicare was convinced that the proposed RVUs were too low for the codes marked in gray boxes, increasing them in the final rule.

Find it here: The final rule is available at www.federalregister.gov/d/2022-23873/page-69404.