Another gut punch to the continued declining reimbursement for anesthesia. The Final Rule was released for the Calendar Year (CY) 2022, and the Medicare National Anesthesia Conversion Factor dropped 2.9%, from $21.56 to $20.93.

Outlined below are changes brought about by the CMS Final Rule that affect anesthesia, both good and bad.

Anesthesia in ASCs

You likely already heard about the back and forth regarding CMS’ removal of 298 surgical codes from the inpatient only list thereby allowing payment for certain procedures in an ASC setting. Two codes were excluded in the Final Rule which means they will continue to be paid in an ASC setting:

  • 01486 – Anesthesia for open procedures on bones of lower leg, ankle, and foot; total ankle replacement
  • 01638 – Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; total shoulder replacement

CMS added 295 of the 298 surgical codes back to the Inpatient Only list and below is a table of 13 ASA codes that will no longer be payable in an ASC setting effective January 1, 2022:

 

ASA Code Procedure Description
00192 Anesthesia for procedures on facial bones or skull; radical surgery
00474 Anesthesia for partial rib resection: radical procedures
00904 Anesthesia for radical perineal procedures
01140 Anesthesia for interpelviabdominal (hindquarter) amputation
01150 Anesthesia for radical procedures for tumor of pelvis
01212 Anesthesia for open procedures involving hip joint; hip disarticulation
01232 Anesthesia for open procedures involving upper two thirds of femur; amputation
01234 Anesthesia for open procedures involving upper two thirds of femur; radical resection
01274 Anesthesia for procedures involving arteries of upper leg, including bypass graft; femoral artery embolectomy
01404 Anesthesia for open or surgical arthroscopic procedures on knee joint; disarticulation at knee
01634 Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; shoulder disarticulation
01636 Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; interthoracoscapular (forequarter) amputation
01756 Anesthesia for open or surgical arthroscopic procedures of the elbow; radical procedures

 

Cardiac

CMS approved an increase in base units for CPT code 00537, cardiac electrophysiolgic procedures including radiofrequency ablation, from 7 base units to 10 base units effective January 1, 2022.

Percutaneous Image Guided Spinal Procedures

Effective January 1, 2022, CMS replaced:

  • 01935 (5 Base Units): Anesthesia for percutaneous image guided procedures on the spine and spinal cord: diagnostic
  • 01936 (5 Base Units): Anesthesia for percutaneous image guided procedures on the spine and spinal cord; therapeutic

with the 6 new codes outlined in the table below:

 

ASA Code Procedure Description Base Unit Value
01937 Anesthesia for percutaneous image-guided injection, drainage or aspiration procedures on the spine or spinal cord; cervical or thoracic 4
01938 Anesthesia for percutaneous image guided injection, drainage or aspiration procedures on the spine or spinal cord; lumbar or sacral 4
01939 Anesthesia for percutaneous image guided destruction procedures by neurolytic agent on the spine or spinal cord; cervical or thoracic 4
01940 Anesthesia for percutaneous image guided destruction procedures by neurolytic agent on the spine or spinal cord; lumbar or sacral 4
01941 Anesthesia for percutaneous image guided neuromodulation or intravertebral procedures 5
01942 Anesthesia for percutaneous image guided neuromodulation or intravertebral procedures 5

 

Colonoscopy

For services rendered on or after January 1, 2022, the coinsurance amount paid for planned colorectal cancer screening tests that require additional related procedures shall be reduced over time as outlined below:

 

  • CY2022: 20% Patient Coinsurance
  • CYs 2023 through 2026: 15% Patient Coinsurance
  • CYs 2027 through 2029: 10% Patient Coinsurance
  • CY 2030: 0% Patient Coinsurance

Per CMS, the reduction over time of the Coinsurance percentage holds true regardless of the code billed for establishment of a diagnosis, for removal of tissue or other matter, or for another procedure that is furnished in connection with and within the same clinical encounter as the screening.

Quality Reporting

CMS developed a new method to report MIPS titled MIPS Value Pathways or MVPs. This will offer anesthesia practices a new reporting method for CY 2023. However, for the CY2022 reporting year, the composite scoring has changed, making it that more difficult for anesthesia practices to avoid a penalty. The table below demonstrates the changes in scoring by category. Stay tuned for our QPP/MIPS specific post in the coming weeks.

Category Score Change from 2021
Quality Performance 30% (10%)
Cost Performance 30% (10%)
Improvement Activities 15% No change
Promoting Interoperability 25% No Change

 

*See the CMS Fact Sheet here: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2022-medicare-physician-fee-schedule-final-rule

*For information regarding the Quality Payment Program: https://qpp.cms.gov/resources/resource-library

Interested in learning how Fusion Anesthesia Solutions can help your practice?

Contact us at sales@fusionanesthesia.com or give us a call at (262) 923-3730.

 

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