Anesthesia Coding Alert

Glean the info you can, but don’t ignore other resources.

Staying on top of all the federal guidelines related to coverage rules and payment amounts can be tricky enough for any coder, but certain nuances associated with anesthesia and pain management add more considerations to your calculations. The good news is that you have virtually all the code payment information you need right at your fingertips once you dig into the Medicare Physician Fee Schedule (MPFS). You just need to know where to find it.

Help is here: Representatives from Part B MAC NGS Medicare aimed to show practices exactly how to do that during the Feb. 13 webinar, “Medicare Physician Fee Schedule Database.” Check out six facts from the session that can help guide your coding knowledge.

Fact 1: Search Online for More Than 10,000 Services

“The database is an online searchable tool that is used to determine correct billing information for successful claim processing on over 10,000 physician services,” said NGS’ Christine Obergfell during the call. “CMS provides the database to all MACs annually and publishes quarterly updates as well.” Staying on top of that information allows practices to have the most current information about payment and coverage information, so it’s important to check in on the data frequently, she advised.

Fact 2: The Database Pairs with Other Resources

Although the database is a great resource, it shouldn’t be used as your sole guide when researching Medicare payments.

“The database is not the only place you should look for information on billing claims to Medicare Part B,” Obergfell said.

You should also check such guidelines as the National Correct Coding Initiative (NCCI)’s code pair edits, local and national coverage determinations, and the medically unlikely edits (MUEs) to ensure you’re coding properly. The American Society of Anesthesiologists’ annual Relative Value Guide is another must-have for anesthesia practices.

Fact 3: Find Coinsurance Estimates

There are two main reasons to use the database, Obergfell said. “The Medicare Physician Fee Schedule is the primary fee schedule that determines how and what to pay for services provided to Medicare patients.”

You’ll find payment amounts in the database that will help you calculate the beneficiary’s coinsurance amount (when applicable) as well, she said. In most cases, the patient’s responsibility will be 20 percent of the fee. You can also find payment amounts for situations such as when you use certain modifiers or if a provider other than a physician is providing the service, she said.

The second reason to use the database is to determine whether any specific payment policies impact the payment for a particular code, such as whether multiple procedures performed at one session would prompt a payment reduction in the subsequent services.

Fact 4: Watch Geography for Accurate Payment Amounts

To pinpoint the exact amount, you’ll receive from your MAC, you’ll have to input your region into the database, since the geographic practice expense is based on your location, said NGS’ Carleen Parker during the call. Therefore, select your locality and area in your MAC’s database to get a handle on your specific payment amounts.

Remember: Pain management “surgical” services are paid based on the national conversion factor (NCF), but anesthesia services are paid based on the anesthesia conversion factor (ACF). Although the ACF is calculated differently than the NCF, geographic location also affects the amount.

Fact 5: Split Out Technical, Professional Fees

If you bill both the technical and professional components of a particular code (when applicable), you’ll see the global fee in the database, but it will also reveal what you’d collect if you only reported the code with modifier 26 (Professional component) appended or if you only reported the technical component using modifier TC (Technical component), she said.

Fact 6: Search for Bilateral or Supervision Data

The database goes beyond showing you payment amounts — you can also use it to search for payment policy indicators, which can show you the professional and technical modifiers, the postoperative days, whether Medicare pays for a particular code, level of physician supervision required, and whether services can be billed bilaterally, Obergfell said.