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SA members should be very familiar with the final rule on the 2008 Medicare Physician Fee Schedule published in the November 1, 2007 Federal Register. The Centers for Medicare & Medicaid Services (CMS) — the agency that oversees the Medicare program — announced a long-awaited increase to the conversion factor used to determine payments for anesthesia services provided to Medicare beneficiaries. As a result of ASA’s efforts, the 2008 Medicare conversion factor for anesthesia services is $17.82 per unit. More information on this exciting update can be found in the “Washington Report” on page 4 of this NEWSLETTER.

What Else Is New for ASA in 2008?
Anesthesia Conditions of Participation
Anesthesiologists should take note of another final rule, also published on November 1. In this ruling, CMS finalized changes to Medicare’s Anesthesia Conditions of Participation (CoP), which were announced in an August 2007 proposed rule. CMS establishes the CoPs, which are standards that a hospital must meet in order to participate in and receive payments from the Medicare or Medicaid programs.

These changes were put forth as a response to the many questions CMS has received about the timing of the postanesthesia note. It is CMS’ belief that the revisions will provide needed clarification, and ASA supported these revisions. In comments submitted in September, we stated that “ASA endorses the changes as proposed by CMS. We agree that they are in the best interests of our patients and provide a necessary update to the current requirements without placing any undue burden on the anesthesiologists’ provision of medical care.”

The CoPs define an individual qualified to administer anesthesia as:

In the text as published in this Final Rule and effective on January 1, 2008, §482.52(b) (1) has been revised to read as follows:

A preanesthesia evaluation completed and documented by an individual qualified to administer anesthesia, as specified in paragraph (a) of this section, performed with 48 hours prior to surgery or a procedure requiring anesthesia services.

§482.52(b) (4) has been deleted.

The CoPs no longer include an inpatient/outpatient distinction for the postanesthesia evaluation. §482.52(b) (3) applies to anesthesia services delivered in either setting. CMS has determined that this is appropriate given the fact that many of the procedures that require anesthesia, which had been provided strictly in an inpatient setting, have now migrated to the outpatient setting.

The members of the ASA Committee on Quality Management and Departmental Administration (QMDA) monitor any issues or changes relevant to the CoPs. In analyzing these revisions, QMDA members have observed that:

CPT ^® Code Changes for 2008
Anesthesia
2008 Current Procedural Terminology (CPT) includes two new anesthesia codes and one deleted code. Code 01905 – anesthesia for myelography, discography, vertebroplasty (five base units) has been deleted and replaced with two new codes:

01935 – Anesthesia for percutaneous image guided procedures on the spine and spinal cord; diagnostic.
01936 – Anesthesia for percutaneous image guided procedures on the spine and spinal cord; therapeutic.

Codes 01935 and 01936 both have five base units. Code 01935 should be used to report anesthesia for myelography and discography. Use 01936 to describe anesthesia for vertebroplasty, kyphoplasty and chemonucleolysis.

Code 01931 has been revised to make its definition of “TIPS” (see below) consistent with that used throughout CPT:

01931 – Anesthesia for therapeutic interventional radiologic procedures involving the venous/lymphatic system (not to include access to the central circulation); intrahepatic or portal circulation (e.g., transvenous intrahepatic portosystemic shunt[s] [TIPS]).

The old descriptor defined TIPS as “transcutaneous porto-caval shunt.” The change did not impact the base unit value assigned to the code.

Pain
While there are no new/revised/deleted pain codes, some of the modifiers that may be appended to these codes have been updated. 2008 CPT’s definition for modifier 22 is now “Increased Procedures Services.” CPT includes notice that when using this modifier, physicians should have documentation that not only describes the additional work but also explains why it was necessary. Other modifier changes include instruction that modifiers 22 and 59 (Distinct Procedural Service) not be appended to an evaluation and management service.

New ASA Position Statements
ASA has received reports that some payers may be inappropriately denying claims for postoperative pain procedures reported in conjunction with an anesthesia service. Furthermore, we still hear of some cases where insurance companies bundle the payment for fluoroscopic guidance into the payment issued for spinal injection procedures. The ASA Committee of Economics authored position statements on each of these issues that were approved by the ASA House of Delegates at the Annual Meeting held in October 2007.

The ASA statement on Reporting Postoperative Pain Procedures in Conjunction With Anesthesia can be found at: www.ASAhq.org/publicationsAndServices/standards/43.pdf.

The statement on Fluoroscopic Guidance for Spinal Injections is at: www.ASAhq.org/publicationsAndServices/standards/44.pdf.

Physician Quality Reporting Initiative
Anesthesiologists can continue to participate in CMS’s Physician Quality Reporting Initiative (PQRI) program and remain eligible to receive a bonus of up to 1.5 percent of their total Medicare allowed charges. The 2008 PQRI program includes 119 measures, up from 74 in 2007. Some of last year’s measures have been deleted from the program while others have been revised, but the delete/revised measures do no apply to anesthesiology. Reporting will continue to be claims-based while CMS explores registry-based reporting options for the future.