2018 Centers for Medicare & Medicaid Services (CMS) Rule Changes

Is your Anesthesia practice aware of all of the code changes for 2018? Incorrect coding could lead to delays in payment, and in some cases, it could completely prevent you from being receiving payment. Even when accurately reported, this code change represents a 40% reduction in base units, and many anesthesia practices are not even aware.

Medical Business Management is here to help! In this post, we give you the bottom line, although this year’s rule changes are complex and compliance is proving to be a challenge for anesthesia practices across the country. Contact MBM today to find out more about how your practice can ensure compliance and prompt payment every time.

2018 CMS Rule Changes

The CPT Editorial Panel is deleting two codes for anesthesia services related to upper GI procedures. Your practice should discontinue using these codes immediately.

  • 00740
  • 00810

They are creating new codes for upper GI procedures, lower GI procedures, and combined upper and lower GI procedures that should be used for all services billed in the 2018 calendar year.

Upper GI Procedures

There are 2 new codes that cover anesthesia for upper gastrointestinal procedures.

  • CPT code 00731 – 5 base units: This code covers anesthesia for upper gastrointestinal endoscopic procedures and endoscope introduced proximal to the duodenum unless otherwise specified.
  • CPT code 00732 – 6 base units: This code covers anesthesia for upper gastrointestinal endoscopic procedures, endoscopy introduced proximal to the duodenum, and endoscopic retrograde and cholangiopancreatography (ERCP).

Lower GI Procedures

The CPT Editorial Panel created a separate set of codes for lower GI procedures.

  • CPT code 00811 – 4 base units: 00811 should be used for anesthesia for lower intestinal endoscopic procedures and endoscope introduced distal to the duodenum unless otherwise specified.
  • CPT code 00812 – 3 base units: This code covers anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; screening colonoscopy).

Upper and Lower GI Procedure Codes

Finally, there is one code for anesthesia for procedures on both the upper and the lower GI.

  • CPT code 00813 – 5 base units: 00813 covers anesthesia for combined upper and lower gastrointestinal endoscopic procedures and procedures where the endoscope introduced both proximal to and distal to the duodenum

Conclusion

The CPT changes for anesthesia procedures are affecting anesthesia practices nationwide. Some practices are already experiencing confusion and delays in payment.

Medical Business Management can help your anesthesia practice cut through the clutter to ensure prompt and accurate payment. Contact us today about how these changes will impact your anesthesia billings.