CMS proposed 2017 physician fee schedule eliminates moderate sedation from endoscopic procedures: 6 things to know

CMS began looking to separate moderate sedation services from procedure codes in all specialties back in 2014, including gastrointestinal endoscopy, according to a statement by ACG, AGA and ASGE. The three major GI societies have been working to educate CMS on the issue; they are concerned removing the moderate sedation code would negatively impact the GI procedure code valuation.

Here are six things to know:

1. The proposed rule separates moderate sedation services from several GI endoscopy procedures under Medicare Part B. However, there wouldn’t be any financial impact on physicians performing their own moderate sedation.

2. Gastroenterologists performing their own moderate sedation would be able to report the procedure code and the proposed moderate sedation code beginning in 2017.

3. The value of most GI procedures will be reduced by 0.1 RVUs for gastroenterologists who use anesthesia professionals for moderate sedation. But the reduction is less onerous than the AMA Relative Value Update Committee’s recommendation of 0.25 RVUs, which is implemented for all other specialties’ procedures where moderate sedation is inherent.

4. CMS created a separate Healthcare Common Procedure Coding System G codes for GI endoscopy procedure moderate sedation; the proposed value for the moderate sedation for GI procedures is 0.10 work RVUs next year and the add-on code for each additional 15 minutes of intraservice time is available but only as a practice expense.

5. Here are the most common GI codes with a proposed percentage RVU change for next year if the sedation is administered by an anesthesia professional:

• Egd diagnostic bush wash: -5 percent to 2.09 work RVU
• Egd biopsy single/multiple: -4 percent to 2.39 work RVU
• Egd place gastrostomy tube: -3 percent to 3.56 work RVU
• Egd guide wire insertion: -3 percent to 2.91 work RVU
• Esoph egd dilation <30 mm: -4 percent to 2.678 work RVU
• Diagnostic colonoscopy: -3 percent to 3.26 work RVU
• Colonoscopy and biopsy: -3 percent to 3.56 work RVU
• Colonoscopy submucous inj: -3 percent to 3.56 work RVU
• Lesion remove colonoscopy: -2 percent to 4.07 work RVU
• Lesion removal colonoscopy: -2 percent to 4.57 work RVU

6. GI anesthesia is also under review for upper and lower GI procedures. CMS proposes maintaining base value for the codes next year, but the agency still believes the services are possibly misvalued and is looking for outside input on how the codes are moving through the CPT and RUC processes.

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