he ASA Relative Value Guide™ (RVG) and the ASA CROSSWALK^® are among the most visible and important publications directed toward the economic aspects of the practice of anesthesiology.

RVG
The American Medical Association publishes the Current Procedural Terminology (CPT^®) code book. CPT is updated annually and contains codes that describe professional services provided by all physicians and other qualified health care professionals. The RVG, also updated annually, lists the CPT codes that are of interest to anesthesiologists, including all anesthesia codes (CPT codes 00100-01999) as well as codes to describe consultative, diagnostic and therapeutic procedures that are commonly performed by anesthesiologists, and codes for modifiers used in reporting anesthesia services, including:

• Evaluation and Management Services

• Pain Management

• Intravascular Catheterization Procedures

• Transesophageal Echocardiography

• Pulmonary Function Testing

• Neurological Monitoring Procedures

• Other

The RVG’s value extends beyond the code listings. It includes italicized “coding comments” that offer guidance from the ASA Committee on Economics on the correct use of specific codes. An example of a “coding comment” is found in the entry for code 01830::

An important part of the RVG is the “Summary of Changes” section. In this section, there are convenient and concise summaries of new, revised or deleted codes, including new or revised coding comments along with any base unit value changes from the previous year. These changes also are noted in the body of the RVG.

The RVG also includes official ASA statements, as approved by the House of Delegates, on issues relevant to coding and payment. The 2007 edition includes:

• Position on Monitored Anesthesia Care

• Distinguishing Monitored Anesthesia Care (MAC) From Moderate Sedation/Analgesia (Conscious Sedation)

• Statement on Intravascular Catheterization Procedures

• Statement on Transesophageal Echocardiography

The RVG was developed in response to the desire to have a rational and consistent methodology to value and report anesthesia services to payers, both public and private. In the 1950s, Joseph H. Failing, M.D., and other California anesthesiologists developed the original California Relative Value Study. In 1962, the ASA House of Delegates adopted the first RVG based on the California RVS. Since 1970, the RVG has been reviewed and revised annually. For his efforts, Dr. Failing received the ASA Distinguished Service Award in 1966.

It is important to note that the RVG is not a fee schedule, but rather is a resource for anesthesiologists and can be used to facilitate determination of professional charges. In the 1970s, several medical organizations, including ASA, came under the scrutiny of the Federal Trade Commission (FTC), which charged that publications such as the RVG represented conspiracies to fix prices. All of the other organizations ultimately agreed to consent orders, the terms of which included the cessation of publishing their guides. The FTC did not specifically “go after” the ASA RVG, but the Justice Department brought suit against ASA in 1975 on the grounds that the RVG represented price fixing and was, therefore, a violation of the Sherman Antitrust Act. The case went to trial in federal court in New York City in December 1978. ASA’s legal counsel at the time, John Lansdale, Esq., developed the legal strategy to fight the case. Several prominent members of ASA testified in the six-day trial, and ASA prevailed. The ASA Lansdale Public Policy Fellowship recognizes Mr. Lansdale’s contribution by providing recipients a year’s study on legislative process and national health care policy.

CROSSWALK^®
The CROSSWALK links CPT diagnostic and therapeutic procedure codes to appropriate anesthesia codes. When there are multiple anesthesia codes that could link to a procedure code, the CROSSWALK will offer alternative anesthesia codes along with guidance on how to select the most appropriate code. In addition the CROSSWALK provides coding comments and guidance for coding selection. Below are examples of CROSSWALK entries (including coding comment in italics).

The CROSSWALK was originally created and developed by Stanley W. Stead, M.D., M.B.A., and the rights to the publication were given to ASA. It was first published in 1994 and is updated each year. Dr. Stead continues to serve as editor of CROSSWALK. He and a group of four experienced members of the Committee on Economics meet annually to review the accuracy and appropriateness of the code links, making the CROSSWALK a dynamic and evolving document.

The Reverse CROSSWALK™ was first offered in 2003. This product is indexed by anesthesia code and links the anesthesia code to all appropriate procedure codes.

The RVG and CROSSWALK are published in both print and electronic format. The Reverse CROSSWALK is currently available only on CD. Thanks to the efforts of Sharon Merrick, CCS-P, ASA’s Coding and Reimbursement Manager, who provides ASA staff support for the Committee on Economics, the updated publications are routinely available in the fall of the year allowing anesthesiologists to report their services with the appropriate existing, revised or new codes as required beginning on January 1 of each year.

Jan Gillespie -Wagner, M.D., is partner, Intermountain Anesthesia Consultants and President, Colorado Physician Services in Fort Collins and Greeley, Colorado.

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

Stanley, W. Stead, M.D., M.B.A., is CEO, Stead Health Group, Inc., and Clinical Professor of Anesthesia and Pain Management, University of California-Davis, Encino, California.