Anesthesia Coding Alert

But brace your offices for 3 areas where you could be hit hard

When it comes to the conversion factor (CF), it's safe to say that a few pennies sure add up. The proposed CF for 2005 is $37.8975, up about 56 cents from 2004's CF of $37.3374 - a change that could mean a big boost in your bottom line next year. Pain Practitioners Should Get Healthy Boost in Pay The good news for pain management practitioners is that you should see higher reimbursement - sometimes much higher reimbursement - for some common procedures. Some of the most significant expected increases are:

64470 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level) - The non-facility fee increases 35.5 percent from $255.76 to $346.49.

64475 (... lumbar or sacral, single level) - The non-facility fee increases 39 percent from $227.01 per injection to $315.50.

+64627 (Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, each additional level [list separately in addition to code for primary procedure]) - The non-facility fee increases by 50.4 percent, from $144.50 to $217.30. "The procedures singled out for these significant increases - facet blocks and rhizotomies - are performed almost exclusively by pain management specialists," according to Abraham Rivera, MD, CEO of Pain Management Medical Group in Albany, N.Y. "These procedures are the bread and butter of a busy pain management practice."

"These are the most common procedures done in a pain management practice, and the most effective," agrees Trish Bukauskas-Vollmer, CPC, owner of TB Consulting in Myrtle Beach, S.C. That's why some coders and practitioners believe they are singled out for such dramatic fee increases.

Several other codes should have modest increases, such as a 16.1 percent boost for +64623 (Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, each additional level [list separately in addition to code for primary procedure]), an 11.8 percent increase for +64484 (Injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar or sacral, each additional level [list separately in addition to code for primary procedure]), and a 10.8 percent increase for 64508 (Injection, anesthetic agent; carotid sinus [separate procedure]). Brace for Decreases in Other Areas Just as things that go up must come back down, your increased reimbursement for some pain management procedures is balanced by decreases for others. The three  biggest expected changes deal with non-facility fees for arthrography procedures:

27093 (Injection procedure for hip arthrography; without anesthesia) decreases 56.5 percent to $221.04.

27095 (... with anesthesia) drops 39.9 percent to $277.79.

27096 (Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid) decreases 49.8 percent to $203.49. Rivera isn't sure how many pain management practices these changes will affect, saying he [...]