Physician fee schedule slashes GI anesthesia reimbursement — 5 insights

Anesthesia Business Consultants President and CEO Tony Mira penned a blog post on the 2018 Medicare Physician Fee Schedule and its effects on reimbursement for gastroenterology anesthesia procedures.

Here's what you should know:

1. The 2018 fee schedule reduces the base unit value for screening colonoscopy from 5 to 3, which is a 28 percent reimbursement reduction, based on an average 7.2 units billed. The base unit value for lower GI procedures will drop from 5 to 4.

2. CMS also replaced CPT codes 00740 (for upper GI procedures) and 00810 (for lower GI procedures) with five new codes that distinguish between different types of procedures.

3. The base unit value for endoscopic retrograde cholangio-pancreatography increased from 5 units to 6 units. This is the only such increase.

4. Mr. Mira estimates the changes "are likely to have a significant impact on revenue for many practices," as payers often fall in line with CMS.

5. Endoscopy cases can represent as much as 30 percent of an anesthesia group's total revenue.

Mr. Mira wrote that ABC encourages anesthesia groups to determine the impact the changes will have to ensure endoscopic settings are managed efficiently. He said, "The change in reimbursement does not reflect the clinical benefits of having an anesthesiologist involved in the procedure or your ability to manage your endoscopic settings more efficiently."

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