Proposed Change Means Endoscopic Anesthesia Reimbursement Reductions are on the Horizon

Update on Final Ruling posted here.


CMS’ 2018 Physician Fee Schedule released July 13 includes a proposed change for screening colonoscopies that would have a significant impact to endoscopic anesthesia reimbursement. Here’s a look at the proposed rule.

A CMS review of Medicare claims data revealed a separate anesthesia service is reported more than 50 percent of the time that various colonoscopy procedures are reported (CY 2016 PFS). As a result, CMS believes that the related CPT codes were misvalued based on the increased utilization of anesthesia.

Should utilization alone determine if a CPT code is misvalued?

abeo doesn’t think so. An anesthesia provider being present during routine colonoscopies increases patient and gastroenterologist satisfaction. Time to take action and make your voice heard if you oppose this change. Voice your opinion to your elected officials and submit a letter to CMS by September 11 to oppose utilization as the rationale used for reducing base units for anesthesia during colonoscopies.

What happens if the proposed rule is passed?

In the proposed rule change, CMS introduces a new series of CPT codes for CY 2018. Comparing the current base units to the proposed new base units for screening colonoscopy represents a twenty percent reduction in base units. Based on an average 7.2 total units billed, that is an approximately fourteen percent reduction in reimbursement.

The CMS RVS Update Committee (RUC) recommended CPT 008X2 reduce to 3 base units. This would result in a forty percent reduction in base units. Following the same average of 7.2 total units billed, this equates to an approximate twenty eight percent reduction in reimbursement.

CMS Propose 2018 PFS - Anesthesia Endoscopy

Impact comparison of current and 2018 proposed CPT code and anesthesia base unit changes for endoscopy procedures.

abeo suggests reviewing the case volume pertaining to these CPT codes to calculate the financial impact this may have on your practice. This may apply to all payors and not just Medicare if ASA adopts this methodology.

abeo clients can discuss the impact this proposed CMS physician fee schedule will have on endoscopic anesthesia reimbursement with their Client Relations Manager (CRM).

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Comments
  • Dr. Ana Shah
    Reply

    I( Monroe Anesthesiology/Dr A Shah) believes that utilization, itself, should not be the criteria used to determine if a CPT code is misvalued. Ongoing research continues to demonstrate that the presence of an anesthesia provider for routine Colonoscopy increases the satisfaction of both the patient & the gastroenterologist while providing an airway trained specialist to care for the patient allowing the gastroenterologist focuses on completing the procedure.
    I would be further concerned that if CMS’ proposed rule change goes into effect, commercial carriers will follow resulting in a significant reduction in overall anesthesia reimbursement for endoscopic procedures based on non-clinical valuation methodology previously cited.

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