Anesthesia Coding Alert

Report the corrent CF depending on your service

Whether your group focuses on anesthesia or pain management, the conversion-factor news for 2006 isn't pleasant: CMS reduced both the Medicare Physician Fee Schedule Database conversion factor (CF) and the anesthesia conversion factor (ACF).

The 2006 national conversion factor is 36.1770, down 4.4 percent from the 2005 factor of 37.8975. The new ACF for 2006 is 16.9591, a 4.51 percent cut from last year's ACF of 17.7594.

You base claims for any non-anesthesia service on the non-anesthesia CF. This includes any pain management services your group provides, such as diagnostic or therapeutic nerve blocks (64400-64530, Injection, anesthetic agent ...).

You also refer to the national CF when reporting surgical services that anesthesiologists often perform, such as Swan-Ganz catheter placement (93503, Insertion and placement of flow directed catheter [e.g., Swan-Ganz] for monitoring purposes).

To determine payment for a procedure, multiple the conversion factor (36.1770) by the RVU (relative value units) assigned to the procedure's code. Remember, ACFs Vary by Location The ACF comes into play when you report anesthesia services. Multiply the procedure's base units by the ACF, then add the appropriate number of time units for your total reimbursement. The area's cost of living, insurance expenses, business expenses and other factors combine to create your local ACF.

State-to-state variation: The 2006 ACF for North Carolina is 16.25, but the 2006 ACF for South Carolina is 15.83. If you code for groups in both states, be sure you-re basing claims on the correct ACF for the state.

Same-state variation: Even if you code for groups within the same state, the appropriate ACF could vary. For example, most of New York has an ACF in 2006 of 16.30, but Manhattan's ACF is 19.43.

CMS publishes the final reimbursement ruling in November of each year, with implementation set for the following Jan. 1. Go online to the Federal Register or the American Society of Anesthesiologists- Web site (www.asahq.org) for the most up-to-date conversion factor information in your region.

Note: This information was current as of press time, but the AMA and other groups were fighting for legislation that would fix Medicare's sustainable growth rate formula rather than continue the proposed cuts (CMS has announced a 26 percent reduction in Medicare physician payments over the next six years). Check future issues of Anesthesia and Pain Management Coding Alert for updates.