Beginning January 1, 2015, we all will be seeing changes in how we bill and receive payment for anesthesia services provided for colonoscopies. Recall, one of the big items of the Affordable Care Act (ACA), was eliminating the patients’ deductible and coinsurance for screening colonoscopies.
On Oct. 31, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a final rule updating payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule (PFS) on or after Jan. 1, 2015. In this policy, CMS defined screening colonoscopy to include anesthesia so beneficiaries do not have to pay coinsurance on anesthesia for a screening colonoscopy when furnished separately by an anesthesia professional.
The Medicare statute waives the Part B deductible and coinsurance applicable to screening colonoscopy. Increasingly, anesthesia separately provided by an anesthesia professional is becoming the prevalent practice in connection with screening colonoscopies, replacing the previously prevalent practice of moderate sedation provided intravenously by the physician doing the colonoscopy. Currently, when a single physician furnishes the moderate sedation and the screening colonoscopy, payment for the colonoscopy includes both services and coinsurance is waived for the entire procedure. When anesthesia for a screening colonoscopy is provided separately by an anesthesia professional, Medicare does not waive the deductible and coinsurance associated with the anesthesia. In the CY 2015 final rule, by revising the definition of a “screening colonoscopy,” CMS is including separately provided anesthesia as part of the screening service so that the coinsurance and deductible do not apply to anesthesia for a screening colonoscopy, reducing beneficiaries’ cost-sharing obligations under Part B.
In order for this to take place, anesthesia providers will have to utilize two modifiers 33 and PT. We will include them on the claim which will tell Medicare that this was a screening colonoscopy. Colonoscopies which are performed when there are signs and symptoms will still fall under the person’s medical benefits and should not be reported with those modifiers. As we understand it today, anesthesia professionals who furnish a separately payable anesthesia service in conjunction with a colorectal cancer screening test should include the 33 modifier on the claim line with the anesthesia service. As noted above in situations that begin as a colorectal cancer screening test, but for which another service such as colonoscopy with polyp removal is actually furnished, the anesthesia professional should report a PT modifier on the claim line rather than the 33 modifier.
Providers will need to include with their billing, the complete diagnosis information in order for the appropriate modifier is attached to the claim.
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Editor: Philip Blann (pblann@anesthesiabilling.com).
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