The Centers for Medicare and Medicaid Services (CMS) plans to remove moderate sedation from more than 120 GI endoscopy codes beginning in 2017, according to the American Gastroenterological Association. Representatives from AGA along with other GI societies met with CMS officials back in February to discuss the agency’s planned changes, along with the impact of reducing the relative value of colonoscopy procedures.
Changes Jeopardize 80 by 2018
According to a recent Becker’s GI & Endoscopy article, “The new measure aims to prevent duplicative payment to the endoscopist for moderate sedation when anesthesia is provided and billed by a second provider.” However, the AGA said these changes would hinder the national goal of having 80 percent of eligible Americans screened for colorectal cancer by 2018, also known as the “80 by 2018 Pledge.”
As well, the organizations emphasized the need for appropriate valuation of moderate sedation that “preserves the value of the endoscopy procedures. If too much value is assigned to moderate sedation, the underlying procedures could be significantly devalued relative to all other procedures.”
Details of the Changes
If CMS follows through on the plan, the AGA said the following would apply to endoscopic procedures beginning in 2017:
- The value of moderate sedation would be removed from over 120 GI endoscopy codes.
- New codes created by CPT would be used to describe administration of moderate sedation when performed by the endoscopist.
- Endoscopists administering moderate sedation during procedures would report the new moderate sedation codes along with the underlying procedural code.
- However, no extra value would be added when the new CPT codes for moderate sedation are reported with the GI endoscopy procedure.
- Endoscopists not administering moderate sedation will report only the underlying procedural code.
Anesthesiologists Currently Unaffected
Anesthesiologists who administer anesthesia during GI endoscopy procedures would continue to be reimbursed separately for their work. The 2015 Medicare Fee Schedule statutorily included separately billable anesthesia services as integral to screening colonoscopies, regardless of the diagnosis or tissue removed, and prohibited Medicare Administrative Contractors (MACs) from applying deductibles for the surgical or anesthesia services for those procedures.
Meanwhile, a recent study published in the journal Gastroenterology claims that the use of anesthesia services is associated with a 13 percent increase in the risk of any complication within 30 days, including an increased risk of perforation, abdominal pain, complications secondary to anesthesia, and stroke.
In that study of claims from 2008 to 2011 in the Truven Health Analytics MarketScan Research Databases, researchers measured colonoscopy complications within 30 days for 3.16 million colonoscopy procedures in men and women between the ages of 40 and 64 years.
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