Moderate Sedation Changes for Bronchoscopy in 2017.

Area of Science:

• Medical billing and reimbursement
• Healthcare economics
• Endoscopic procedures

Background:

• Reimbursement policies for moderate (conscious) sedation have undergone significant changes effective January 1, 2017.
• The Centers for Medicare & Medicaid Services (CMS) observed increased utilization of anesthesia services for moderate sedation during endoscopic procedures.
• CMS decided to remove work relative value units (wRVUs) from services involving moderate sedation, specifically impacting bronchoscopy codes.

Purpose of the Study:

• To inform healthcare providers about critical changes in reimbursement for moderate sedation.
• To clarify how bronchoscopists can maintain revenue for providing moderate sedation.
• To emphasize the importance of understanding updated coding and billing practices for appropriate financial compensation.

Main Methods:

• Analysis of Centers for Medicare & Medicaid Services (CMS) policy updates regarding moderate sedation reimbursement.
• Review of coding and billing guidelines for endoscopic procedures, including bronchoscopy.
• Identification of specific scenarios where providers can reclaim revenue for moderate sedation services.

Main Results:

• Work relative value units (wRVUs) were removed from many moderate sedation services, including bronchoscopy codes, by CMS.
• Bronchoscopists who administer moderate sedation without involving anesthesia services or other qualified providers can still bill for this work.
• Appropriate use of relevant billing codes is crucial for recouping lost revenue.

Conclusions:

• Understanding the 2017 changes in moderate sedation coding and billing is essential for appropriate reimbursement.
• Bronchoscopists should utilize correct coding practices when they provide moderate sedation independently to ensure revenue capture.
• Healthcare providers must stay informed about policy shifts to optimize financial performance in light of evolving reimbursement landscapes.