Anesthesia Coding Alert

The anesthesia starting point will be $22.2730.

Anesthesia providers will see an uptick in their Medicare reimbursement in 2019, thanks to a small boost to both the National Conversion Factor (NCF) and the Anesthesia Conversion Factor (ACF).

Bottom line: The National Medicare Conversion Factor (for non-anesthesia services) will show a few-cents increase for inflation: from approximately $35.99 in 2018 to $36.0391 in 2019. The 2019 Medicare National ACF will increase from $22.1887 in 2018 to $22.2730 in 2019.

Remember, however, that you won’t automatically apply the national ACF when calculating your claims. ACFs vary by state and/or geographic location because of local economic and practice expense factors. You’ll use the specific ACF for your geographic area, says Kelly Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fl.

For example, the ACF for Mississippi is $20.96 while the ACF for Queens, NY is $25.40. There can also be conversion factor differences within different areas of a state. Consider these two examples:

• Seattle is $23.16, while the rest of Washington State is $22.18
• Metropolitan Philadelphia is $23.43, while the remainder of Pennsylvania is $22.09

You’ll find the full list of ACFs by locale on the CMS website (https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Downloads/2019-Anesthesia-Conversion-Factors.zip).

Put it to practice: The ACF is only one piece of the puzzle that makes up your provider’s reimbursement. The allowance for anesthesia services is based on the following formula:

(Time Units + Base Units) X Conversion Factor = Allowance

• Base Units= Anesthesia procedure performed has an assigned code and each code has a base unit value.
• Time Units= Amount of time taken for each anesthesia procedure.
• Conversion Factor= Cost assigned for each unit and are specific to the location of the anesthesia provider.
• Total Anesthesia Charge= The total number of units together it is multiplied by the conversion factor and the total anesthesia charge is calculated.

“Although CMS hasn’t added the 2019 anesthesia base units by CPT^® code, there are a handful of anesthesia codes with a CMS base value that is less than the suggested value from the American Society of Anesthesiologists,” Dennis says. “This is a good thing to remember when calculating your expected payments.”

One last tip: “I also think it is helpful to make sure that CMS penalties and sequestration are separately accounted for when payments are posted,” Dennis adds.