Anesthesia Coding Alert

Lower national and anesthesia CFs mean less reimbursement

The verdict is in: CMS has reduced both the Medicare Physician Fee Schedule Database conversion factor (CF) and the anesthesia conversion factor (ACF) - both at the expense of your bottom line.
 
The 2004 national conversion factor is $35.1339, down 4.5 percent from the 2003 factor of $36.7856, and the new ACF is $16.43, a 3.6 percent drop from last year's ACF of $17.05.

Interpret the Reductions for Your Practice

Anesthesia and pain management providers are unique because both conversion factors affect their practices. That means as a coder, you need to pay attention to the services provided and how to report the associated CFs.
 
The Medicare conversion factor (sometimes called the national CF) designates the amount Medicare will pay per unit for any surgical procedure. Medicare and some other carriers use this conversion factor as the base dollar amount they multiply by the relative value units (RVUs) of procedures to calculate the national payment rate for procedure codes.
 
You base claims for any non-anesthesia services - including pain management services such as diagnostic or therapeutic nerve blocks (64400-64484) or trigger point injections (20552-20553) - on the national CF.
 
Remember, however, that although the ACF is set, this is a national recommendation that can vary depending on your practice location. The area's cost of living, business expenses, insurance expenses and other variables combine to create the local ACF you should use.
 
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 the ASA's Web site (www.asahq.org) for more information on the updated conversion factors.