Anesthesia Coding Alert

Still trying to figure out where to find the 1.1 percent increase is on your 2009 conversion factor of 36.0666, compared to the current 38.0879? In anesthesia, you should notice a larger increase.

The 2009 Physician Fee Schedule includes a nearly 5 percent increase to the national unadjusted Medicare anesthesia conversion factor.-Beginning Jan. 1, 2009, the conversion factor will be $20.92, up from $19.97 in 2008.

The increase is a result of provisions included in H.R. 6331, the Medicare Improvements for Patients and Providers Act (MIPPA), which became law on July 15, 2008.-Specifically, MIPPA provided a 1.1 percent conversion factor increase, and implemented a new formula for calculating budget neutrality, which accounted for approximately an additional 3 percent improvement.

How much Medicare pays per relative value unit (RVU) comes from many areas, says Amy Bassano, with CMS in "Medicare Physician Payment Schedule 2009 Changes and Beyond" at the CPT and RBRVS 2009 Annual Symposium in Chicago. While a 1.1 percent update was required to the physician fee schedule, budget neutrality for the third of five-year review also came into play.

"The AMA really fought for the 1.1 percent increase," says Sherry L. Smith, MS, CPA, director of physician payment policy and systems for the AMA during the same session. This will really benefit physicians. For instance, a 99213 (Office or other outpatient visit for the evaluation and management of an established patient . . .), will increase nearly 3 percent.

The change comes in where the budget neutrality adjustor (BNA) is applied. In 2008, the BNA was applied to the work practice expense (PE) portion of all CPT code's RVUs. However, for 2009, the BNA will be applied directly to the conversion factor. Essentially, codes comprised mainly of work PE will get a boost for 2009. In comparison to those codes with RVUs based mainly on high equipment expense, such as diagnostic services, rather than work, however, may decrease in pay, Smith said.