he “Many Missions of the Committee on Economics” of ASA were discussed in an article in the July 2004 issue of the ASA NEWSLETTER.

This article will update the membership on issues faced and tasks accomplished by the committee over the past year.

Of special interest to all ASA members is the work being done by the Task Force on Payment Methodology, which was convened as a result of a recommendation the committee made to the 2003 ASA House of Delegates (HOD). While the committee is not directly involved in the deliberations of the task force, several current and past members of the committee serve on it and provide valuable historical information and perspective.

The Relative Value Guide (RVG) is perhaps the most visible work product of the committee. (I would recommend that everyone read the excellent article in the November 2004 issue of the NEWSLETTER by Babatunde O. Ogunnaike, M.D., and Adolph H. Giesecke, M.D., on the history of the ASA RVG.) Several changes to the “Forward,” “Anesthesia Guidelines” and Obstetric Anesthesia” sections were proposed to and accepted by the 2004 HOD. Since electronic claims are now required to use the most current codes in effect on January 1 of each year, the committee had to finalize the 2005 RVG before the Annual Meeting to allow publication and distribution before this new deadline. The HOD met after our press deadline, so these changes will appear in the 2006 RVG. All new or revised codes will be found in the “Summary of Changes” found on page vi of the 2005 RVG.

From time to time, as part of the American Medical Association Current Procedural Terminology (CPT™) code development and the Relative Value Update Committee (RUC) code valuation processes, it is necessary to survey selected members — from all practice styles — of ASA. If you, or a member of your group, receive a survey, it is vitally important for the survey to be completed and returned. By doing so, members have an opportunity to directly participate in the economic matters deliberated by ASA.

CPT code 99100, “Anesthesia for patient of extreme age, under 1 year and over 70,” like Physical Status Modifiers P1-6, is not recognized by Medicare but is reported by some practitioners on elderly patients not covered by Medicare. The committee, along with the chair of the ASA Committee on Geriatric Anesthesia, is of the opinion that while not all patients greater than 70 years of age represent an increased risk for anesthesia and surgery, age may be a factor in determining patient “frailty.” The problem of how to determine and report frailty was discussed in two articles in the ASA NEWSLETTER (“Ventilations” by Mark J. Lema, M.D., Ph.D., in June 2003, and “Geriatric Anesthesia Enters a New Age” by Jeffrey H. Silverstein, M.D., in May 2004). The committee made a recommendation, which was approved by the 2004 HOD, that the president refer to a committee of his choice the issue of how to better define Physical Status Modifiers and risk-stratification reporting. The goal is to have a system that would allow the membership to better describe degrees of frailty that complicate anesthesia care for a specific patient and hopefully have that be a factor in determining payment for anesthesia services.

The issue of reporting field avoidance or unusual positioning is one that is cause for consternation. While there is no “field avoidance” code, nor is one contemplated, the committee is involved in an ongoing effort to identify those surgical procedures in which field avoidance or positioning complicate anesthesia care and assure appropriate values for those anesthesia codes.

The committee is of the opinion that there is continuing confusion on the part of payers (and likely some practitioners) between monitored anesthesia care (MAC) and conscious sedation (CS), whether the CS is administered under the supervision of the “operating practitioner” or by a second provider. A workgroup of committee members developed a statement called “Distinguishing Monitored Anesthesia Care (MAC) from Moderate Sedation/Analgesia (Conscious Sedation).” The statement was approved by the 2004 HOD and is available on the ASA Web site at <www.ASAhq.org/publicationsAndServices/standards/35.pdf>. It will appear in the 2006 RVG immediately following the “Position on Monitored Anesthesia Care” statement. Adequate recognition and payment for CS by the operating practitioner or by a second (nonanesthesiologist) provider are “hot button” items for many specialties. In the event that CPT creates new codes to address these concerns, the committee, through its representatives at CPT and the RUC, will actively pursue the best interests of our patients and our Society.

The committee membership includes representatives from private and academic practices, “teams” and practices in which anesthesiologists personally provide care, and a resident member. Our liaisons with a number of subspecialty organizations, including the Society for Obstetric Anesthesia and Perinatology (SOAP), the Society of Neurosurgical Anesthesia and Critical Care (SNACC), the Society of Academic Anesthesiology Chairs/Association of Anesthesiology Program Directors (SAAC/AAPD), the Anesthesia Administration Assembly and other societies for pain and critical care, also help the committee to address the concerns of all anesthesiologists. Karin Bierstein, J.D., ASA Assistant Director of Governmental Affairs (Regulatory), and Sharon Merrick, ASA Coding and Payment Analyst, provide invaluable support for all the activities of the committee.

James P. McMichael, M.D., is a partner at Capitol Anesthesiology Association, Austin, Texas.