Anesthesia Coding Alert

Its a typical day in the billing/coding area of a busy anesthesia practice, and the conversation is pretty typical, too. I know we have to use RVUs to get reimbursed. They tell carriers how complicated a procedure is and, basically, how much to pay. But these RVUs can be a coding nightmare: ASA and HCFA give different values to the same codes. If we consistently bill with either ASA or HCFA codes we could lose money. If we keep switching between the two, it gets confusing and time-consuming. And local carriers? Thats another story! How did all this start anyway? Why are there so
many discrepancies?

Understand the Story, Then Code Wisely

HCFA adopted ASAs Relative Value Guide in 1988 as a way to designate a procedures value. But, theres a hitch. ASA publishes RVU changes annually, yet HCFA has not updated its version of sanctioned RVUs since 1992. And, though HCFA might accept new anesthesia CPT code each year, it negotiates with ASA and the AMA before deciding which RVUs to use with the new codes. Thats the crux of the coders dilemma.

These RVU discrepancies, evident in many established codes, are cropping up in new codes as well. For example, the new anesthesia code, 00537 (anesthesia for cardiac electrophysiologic procedures including radiofrequency ablation), has an ASA base value of 10; HCFA lists it as 7. And 00635 (anesthesia for procedures in lumbar region; diagnostic or therapeutic lumbar puncture) has an ASA value of 5, but a HCFA value of 4.

However, the value differences dont always favor using ASA codes. HCFA has a higher base value for code 01215 (anesthesia for open procedures involving hip joint; revision of total hip arthroplasty), with 10 RVUs as opposed to 8 from ASA. Code 01112 (anesthesia for bone marrow aspiration and/or biopsy, anterior or posterior iliac crest) also has a higher HCFA base value (5) than ASA (4).

To make matters even more confusing, some of HCFAs existing RVUs for procedures might decrease from one year to the next, because HCFAs goal is to keep the Medicare budget neutral. So, it decreases some procedures base units to help meet the overall demand of new codes that need RVUs.

Look at More than Money Before Choosing RVUs

Knowing which RVU system to follow can be simple, says Devona Slater, CMCP, president of Auditing for Compliance and Education Inc., a consulting firm in Leawood, Kan., that focuses on physician compliance plans in anesthesia and pain management. We do several things to simplify the process. We bill all carriers with ASA units, participate with Medicare, and have a contractual file that is individually loaded by carrier to note differences in the procedure RVUs. [...]