Anesthesia Coding Alert

As anesthesia coders and practitioners flip their calendars to 2002, they will prepare for reimbursement based on lower conversion factors for the year. The physician fee schedule for 2002 published in the Federal Register goes into effect Jan. 1, 2002, and includes important changes that coders need to know.
Medicare and Anesthesia Changes
One conversion factor change that affects medical practitioners across the board is a lower Medicare Part B conversion factor, what Medicare will pay per unit for any given procedure. The new conversion factor for 2002 is $36.1992, a 5.4 percent reduction from the 2001 conversion factor of $38.2581. This conversion factor is the base dollar amount that is multiplied by the relative value units (RVUs) of each procedure to calculate the national Medicare payment rate for procedural codes based on RVUs.
 
Because anesthesia reimbursement is based on procedure units plus time units instead of just RVUs, anesthesia has its own conversion factor. A national average conversion factor for anesthesia (ACF) is set, but the actual local factor used by practitioners can vary depending on the area's cost of living, business expenses, insurance expenses and more. For example, nine different anesthesia conversion factors will be in effect for California in 2002, ranging from a high of $18.23 for San Francisco to a low of $16.48 for much of the rest of the state. Other highly populated states such as New York and Texas also have several different conversion factors in place. Although the anesthesia conversion factor is the same throughout states such as Montana and New Hampshire, it often is still below the national average factor. (Montana's anesthesia factor for 2002 is $15.33, and New Hampshire's is $16.29.)
 
The national average conversion factor for anesthesia (ACF) will be $16.60 effective Jan. 1, down 6.9 percent from the average ACF for 2001 of $17.83. This change will affect providers' reimbursement levels. Consider these comparisons of how the same procedure would be reimbursed based on the ACFs for 2001 and 2002.
Example 1
Coronary artery bypass graft (CABG) surgery is performed on a patient (using, for example, 33511, coronary artery bypass, vein only; two coronary venous grafts). The base amount for anesthesia during this procedure is 20 units. If the procedure takes six hours and 21 minutes to complete, that equals 26 time units (four 15-minute time units for each of six hours and two 15-minute time units for the extra 21 minutes). The 26 time units are added to the 20 base units for a total of 46 units that the anesthesiologist can charge for the procedure.
 
If the patient is [...]