Anesthesia Coding Alert

CF and ACF numbers look grim unless fix occurs.

Conversion factor news for 2011 is still somewhat up in the air, but the potential cuts look ominous for anesthesia practices.

"The calendar year 2011 Physician Fee Schedule conversion factor is $25.5217," notes the 2011 Medicare Physician Fee Schedule Final Rule, printed in the Nov. 29 Federal Register. This amounts to a dismal 30 percent cut compared to the current rate of $36.8729.

"While Congress has provided temporary relief from these reductions every year since 2003, a long-term solution is critical," the Fee Schedule notes. "We are committed to permanently reforming the Medicare payment formula."

The 2011 national anesthesia conversion factor (ACF) is even worse, according to the Final Rule: $15.8085. Check your specific area, however, because anesthesia reimbursement varies from state to state -- and even within regions of the same state.

Example: Information from TrailBlazer Health Enterprises lists 2011 ACFs in Texas ranging from $15.28 to $16.12 for participating physicians and $14.52 to $15.31 for nonparticipating physicians (assuming the national ACF remains at $15.8085). TrailBlazer covers Colorado, New Mexico, Oklahoma, Texas, and Virginia.

Keep an Eye on Both Factors

As an anesthesia or pain management coder, you might rely on both conversion factors, depending on your providers' specialties. Be sure to calculate your providers' expected allowance based on the correct factor to ensure accurate payment.

National CF use: Base claims for any non-anesthesia services on the non-anesthesia (or national) CF. This includes any pain management services your group provides, such as diagnostic/ therapeutic nerve blocks (64400-64530, Injection, anesthetic agent ...).

Also refer to the national CF when reporting surgical services that anesthesiologists might perform in conjunction with anesthesia administration. Examples include Swan-Ganz catheter placement (93503, Insertion and placement of flow directed catheter [e.g., Swan-Ganz] for monitoring purposes) or arterial line insertion (36620, Arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure]; percutaneous; or 36625, ... cutdown).

To determine payment for a procedure, multiply the conversion factor (25.5217 at press time) by the RVU (relative value unit) amount assigned to the procedure's code.

How the ACF works: 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, which means the ACF varies from one state to another.

Last-Minute Fix Could Be In the Works

The U.S. Senate passed a quick, one-month extension of the current SGR formula on November 18 in a first step to avoid the 23 percent payment cut physicians were facing on December 1. The House of Representatives had already recessed for Thanksgiving and were expected to take up the one-month fix when they returned on November 29.

"While I am pleased that the Senate has acted swiftly on the pending payment cut and the House is expected to act upon its return from the Thanksgiving break, I remain concerned about another round of short term fixes," ASA President Mark Warner, MD, noted in a published statement. "I hope that the ultimate result of this Congressional session will be a fix of at least one year. This extended period must then be followed by a strong bipartisan commitment from Congress to work with the physician community to finally replace the badly flawed SGR formula with a new update mechanism that works," he added. "The frequent disruptions and delayed payments caused by the current formula and Congress' inability to fix it except for short periods are simply unfair to our members who have payrolls and other practice management expenses."

Bottom line: Physicians don't know exactly what will take place at the end of this month or when the calendar turns to 2011. "We have no idea what will happen in Congress in January regarding the conversion factor," says Michael A. Ferragamo, MD, FACS, a clinical assistant professor at the State University of New York at Stony Brook. Some newly-elected Senators and House members will be in place in 2011. As Ferragamo notes, however, it's unclear whether the current Congress will make changes affecting 2011 pay before January, or whether they'll leave the issues for the new Congress to handle.

Get updates: 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 and how it will affect your practice.