Anesthesia Coding Alert

"The procedures singled out for these significant increases - facet blocks and rhizotomies - are performed almost exclusively by pain management specialists," according to Abraham Rivera, MD, CEO of Pain Management Medical Group in Albany, N.Y. "These procedures are the bread and butter of a busy pain management practice."

"These are the most common procedures done in a pain management practice, and the most effective," agrees Trish Bukauskas-Vollmer, CPC, owner of TB Consulting in Myrtle Beach, S.C. That's why some coders and practitioners believe they are singled out for such dramatic fee increases.

Several other codes should have modest increases, such as a 16.1 percent boost for +64623 (Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, each additional level [list separately in addition to code for primary procedure]), an 11.8 percent increase for +64484 (Injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar or sacral, each additional level [list separately in addition to code for primary procedure]), and a 10.8 percent increase for 64508 (Injection, anesthetic agent; carotid sinus [separate procedure]).

Brace for Decreases in Other Areas

Just as things that go up must come back down, your increased reimbursement for some pain management procedures is balanced by decreases for others. The three  biggest expected changes deal with non-facility fees for arthrography procedures:

Rivera isn't sure how many pain management practices these changes will affect, saying he doesn't believe many pain management specialists perform these injections in the office. The physician can possibly administer these injections without an x-ray machine, which is why Rivera thinks the fees drop dramatically.
"There's always been a lot of controversy over these procedures, especially the SI joint injection," Bukauskas-Vollmer adds. "Some physicians were administering the injections without fluoroscopy or arthrography, but were still receiving the high reimbursement." Because of this, some coders believed it was just a matter of time before Medicare lowered the differential.

Verify the Correct Fee

Non-facility reimbursement for many pain management procedures is traditionally higher than reimbursement for the same procedure in a facility (hospital). That's to help offset the physician's additional fees of owning the facility and equipment instead of relying on a hospital to provide it. When reporting any of these services, verify that you report the correct place of service code (usually 11 [Office], 22 [Outpatient hospital] or 24 [Ambulatory surgical center]).

CMS publishes the final reimbursement ruling in November of each year, with an implementation date of the following Jan. 1. Check resources such as the Federal Register or ASA's Web site (www.asahq.org) for more information on the updated conversion factor and how to prepare for it.

Note: Details about the anesthesia conversion factor (ACF) used when calculating anesthesia services were not available when this article went to press.