Anesthesia Coding Alert

Trigger point, facet joint and epidural injections are the "meat and potatoes" of pain management practices. All three of these important treatments have new reimbursement levels beginning this month, when the new conversion factors and Medicare fee schedules for 2003 go into effect. Payers base reimbursement on where the physician performs the service as well as the procedure itself. So your first step is to correctly code the place of service. Services provided in a hospital, a skilled nursing facility, or an outpatient care center are considered "facility" services. Those provided in a physician office, patient home, or similar environment are "nonfacility" services. Reimbursement for nonfacility services is traditionally higher than for facility services to help offset extra expenses the provider incurs (such as equipment, medications, nursing and other technical personnel services, etc.). But unfortunately for providers, reimbursement for some of the most common pain management procedures decreases this year. Some of these cuts are partially offset by increased reimbursement for related procedures, but the overall trend is downward. For example, the nonfacility total payment for 64470 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level) in 2002 was $216.83. The same procedure's reimbursement in 2003 increases to $240.76 (based on the national conversion factors of $36.1992 for 2002 and $34.5920 for 2003). That's a plus for providers, but reimbursement for each additional injection (+64472, ... cervical or thoracic, each additional level [list separately in addition to code for primary procedure]) drops from $191.13 to $116.58. Changes in facility reimbursement for these two injection codes aren't as dramatic, but they still decrease. Single-level reimbursement drops from $88.69 in 2002 to $87.86. Additional-level reimbursement declines from $61.90 to $58.81. Several other injections follow the same reimbursement pattern nonfacility fees for single injections increase in 2003, but fees for additional levels drop. Many coders and practitioners feel that this is Medicare's way of trying to make physicians feel they're getting something when really they're not. Reimbursement for the initial level (injection) goes up slightly, but reimbursement for the additional level(s) decreases. The only way a physician comes out ahead is if he only performs one level, which is rare. But coders acknowledge that it could have been worse reimbursement for both codes could have dropped instead of for just one. Watch for Radiological Guidance Another big reimbursement change applies to 27096 (Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid). The nonfacility fee jumps from $374.30 to $406.80 (although facility fees decrease from $66.24 to $62.96). According to the note beneath the descriptor, you should report 27096 only when the physician uses radiological guidance for the procedure (the note states, "27096 is to be used [...]