December 2005 Volume 69	Number 12

or 2006, the national average Medicare conversion factor for anesthesia services is $16.96, down 4.5 percent from the 2005 level of $17.76. The Medicare conversion factor for other services including visits, pain medicine and critical care drops by the same percentage, from $37.90 to $36.18. This 4.5-percent cut is the result of the vicissitudes of the Sustainable Growth Rate (SGR) annual update formula discussed in several recent “Washington Report” columns. It is reflected in the 91 individual locality conversion factors appearing in Table 1. At press time, ASA was still working hard with the rest of organized medicine to obtain a congressional override and a positive update to the conversion factors. If, as we hope, the effort is successful, we will publish a revised table.

Table 2 lists the anesthesia conversion factors and the percentage by which they changed from year to year since the inception of the Medicare Fee Schedule in 1992.

2006 Current Procedural Terminology (CPT^®) Codes
New CPT^® codes will go into effect on January 1, 2006. Like last year, there is no grace period, so you must become familiar with the new codes and be sure to update your computer systems, fee tickets and any other coding resources so that you are ready for the new codes on January 1, 2006. Changes relevant to anesthesiology and pain medicine practices appear in several chapters of the CPT book. Please see the discussion below, as well as Table 3 for a complete listing.

Evaluation and Management (E/M)
The codes describing Follow-up Inpatient Consultations (CPT codes 99261 through 99263) and the codes describing Confirmatory Consultations (CPT codes 99271-99275) have been deleted. The CPT instructions direct users to consider the Subsequent Hospital Care codes 99231-99233 for services that had been reported under deleted codes 99261-99263. Use the appropriate E/M code (as determined by level of service and setting) to report work previously described by codes 99271-99275.

Anesthesia
Anesthesia code 01964 – Anesthesia for abortion procedures – has been deleted. In its place are two more specific codes:

01965 – Anesthesia for incomplete or missed abortion procedures

01966 – Anesthesia for induced abortion procedures

The ASA Relative Value Guide (RVG) assigns 4 base units to both of these new codes, which is the same value as was assigned to the deleted code.

Pain Management
CPT 2006 attempts to end existing confusion over how to report percutaneous vertebral augmentation (commonly known as kyphoplasty). There are separate codes to report the procedure when performed on the thoracic spine and on the lumbar spine; there is also an add-on code to report each additional thoracic or lumbar level. Radiological supervision and interpretation are reported with codes 76012 or 76013. Anesthesia for percutaneous vertebral augmentation would be reported with code 01905 – Anesthesia for myelography, discography, vertebroplasty (5 base units).

Pathology
With assistance from representatives from the Malignant Hyperthermia Association of the United States (MHAUS), ASA successfully petitioned for a code to describe the Caffeine Halothane Contracture Test. The code (89049) includes performance of the test and interpretation and reporting of the results.

Medicine
The section on Moderate (Conscious) Sedation has been completely reworked. It is important to note that anesthesiologists provide anesthesia (0XXXX codes) services. The Moderate Sedation codes were developed for cases where nonanesthesiologist physicians sedate patients. In fact, the new instructions state categorically that “moderate sedation does not include minimal sedation (anxiolysis), deep sedation or monitored anesthesia care (00100-01999). Both former codes (99141 and 99142) have been deleted. In their place, we have two sets of new and more detailed codes. The first set describes the scenario in which the moderate sedation service is provided by the same physician performing the diagnostic or therapeutic procedure. This set requires the presence of a trained observer to assist the physician in monitoring the patient. The second set applies when the sedation is provided by a second physician in addition to the one performing the procedure. Both sets of codes provide separately for patients less than 5 years of age and for patients age 5 years or older. There are primary codes for the first 30 minutes of intra-service time and add-on codes for each additional 15 minutes of intra-service time.

The introductory text defines intra-service time as “start[ing] with the administration of the sedation agent, requires continuous face-to-face attendance, and ends at the conclusion of personal contact by the physician providing the sedation.”

Both the 2005 and the 2006 CPT books contain, in Appendix G, a listing of procedures for which Moderate Sedation is considered to be inherent in the procedure and not separately reportable. Anesthesiologists may continue to report an anesthesia code for an Appendix G procedure.

Anesthesia and Pain Medicine Coding Changes for 2005