As we’ve mentioned before, aging populations, an increase of cardiovascular conditions, and patient pain management will lead to a rise in the need for anesthesia services leading up to 2025 and beyond. CMS is constantly refining codes as changes in surgeries and procedures require billing costs that accurately reflect them.
In 2022, most of these changes respond to an increase in anesthesia needs for pain management. Many procedures under one code have been expanded to multiple codes to describe the level of care required more accurately. Three primary local coverage determinations have significant changes: managing pain, spinal procedures, and cardiac procedures.
LCD Changes for Chronic Pain Management
CMS decided that some chronic pain codes, including facet joint neurolytic codes and facet joint ablation codes, were over-valued. You can expect a slight decrease in the work RVUs associated with these primary codes. Add-on codes, however, keep the current value. Here’s a rundown of the RVU changes:
| Code | Descriptor | Current RVU | New RVU |
| 64633 | Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint |
3.84 |
3.31 |
| 64634* | Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional facet joint |
1.32 |
1.32 |
| 64635* | Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional facet joint |
3.78 |
3.32 |
| 64636* | Destruction by neurolytic agent,
paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional facet joint |
1.16 |
1.16 |
*(List separately in addition to code for primary procedure)
LCD Changes for Spinal Procedures
Anesthesia for spinal procedures requires special care and attention. CMS has introduced six more detailed codes to allow for a more refined billing process. The two existing codes - 01935 and 01936 (anesthesia for percutaneous image-guided procedures on the spine and spinal cord) - have base values of five. These two will be deleted.
Only two of the new codes retain a base value of five; the other four have a base value of four. Here are the six new codes that replace 01935 and 01936:
| Code | Descriptor | Base Unit Value |
| 01937 | Anesthesia for percutaneous image-guided injection, drainage or aspiration procedures on the spine or spinal cord; cervical or thoracic |
4 |
| 01938 | Anesthesia for percutaneous image-guided injection, drainage or aspiration procedures on the spine or spinal cord; lumbar or sacral |
4 |
| 01939 | Anesthesia for percutaneous image-guided destruction procedures by neurolytic agent on the spine or spinal cord; cervical or thoracic |
4 |
| 01940 | Anesthesia for percutaneous image-guided destruction procedures by neurolytic agent on the spine or spinal cord; lumbar or sacral |
4 |
| 01941 | Anesthesia for percutaneous image-guided neuromodulation or intravertebral procedures (eg, Kyphoplasty, vertebroplasty) on the spine or spinal cord; cervical or thoracic |
5 |
| 01942 | Anesthesia for percutaneous image-guided neuromodulation or intravertebral procedures (eg, Kyphoplasty, vertebroplasty) on the spine or spinal cord; lumbar or sacral |
5 |
Learn more about these code changes and what else is new in anesthesia for 2022 in this blog!
LCD Changes for Cardiac Procedures
There are fewer code introductions and deletions for this LCD, just a base unit value change. This change realigns the value of the code to match the value assigned in the Relative Value Guide. The descriptor will stay the same, but the base unit value moves from 7 to 10:
| Code | Descriptor | Current Base Value | New Base Value |
| 00537 | Anesthesia for cardiac electrophysiologic procedures, including radiofrequency ablation |
7 |
10 |
It may seem superfluous, but we recommend printing out and taping these changes up somewhere handy until you are familiar with them, especially if your practice utilizes them often. Making billing mistakes can be costly, and there have been lots of CMS changes for 2022.
If you need help updating your anesthesia billing practices, contact us today!
