Payment & Practice Management  |   February 2018
Potentially Misvalued Codes
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Practice Management / Payment & Practice Management
Payment & Practice Management   |   February 2018
Potentially Misvalued Codes
ASA Monitor 02 2018, Vol.82, 64-67.
ASA Monitor 02 2018, Vol.82, 64-67.
After a lengthy period of stability, this year brought with it some significant and substantial changes to anesthesia billing and coding. In its proposed rule for the 2016 Medicare Physician Fee Schedule, the Centers for Medicare & Medicaid Services (CMS) identified two long-standing codes that described anesthesia for upper and lower GI endoscopy as “potentially misvalued”. Since that time, ASA worked with CMS and through the CPT® and AMA/Specialty Society Relative Value Scale Update Committee (RUC) processes to advocate for an accurate valuation of these anesthesia services. That work culminated with the deletion of the two codes that were identified as potentially misvalued and the creation of a series of five new codes that more specifically describe these anesthesia services. The increased specificity is accompanied by variation in the base unit values assigned to these services (see Table 1). We also saw changes to the values assigned to the placement of invasive lines subsequent to those services being labeled as potentially misvalued (see Table 2 for the 2017 and 2018 Medicare allowed amounts for these services when performed in the facility setting – prior to geographic adjustments). This month’s Payment and Practice Management Column will discuss the concept of potential misvaluation: how codes are identified as such and what happens once they are.
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