COST CONTAINMENT

Nothing in this section shall preclude an employer (or insurance carrier) from entering into payment agreements to promote the continuity of care and the reduction of health care costs. Such payment agreements, if less, will supersede the limitation amounts specified herein. Please refer to K.S.A 44-510i(e) for further clarification, if necessary.

NATIONAL CORRECT CODING INITIATIVE (NCCI) EDITS: In order to promote correct coding methodologies and to control improper coding leading to inappropriate payments, the Kansas Division of Workers Compensation Schedule of Medical Fees recognizes the 2014 National Correct Coding Initiatives (NCCI) Edits as established by the Centers for Medicare and Medicaid Services (CMS) as the primary standard of reference. The NCCI Edits are not requirements, nor are they mandates or standards; they simply provide advice for correct coding methodologies. Bills must be itemized by procedure code, date of service, and amount of charge.  

CALCULATION EXAMPLES:

1: In a procedure with a Basic Unit Value of 3.0 requiring one hour and forty-five minutes of anesthesia time, the total value should be determined as follows: 

 Basic Unit Value = 3.0 units 

 105 minutes÷15 minutes = 7.0 units 

 Total value = 10.0 units 

2: In a procedure with a Basic Unit Value of 10.0 requiring four hours and twenty minutes of anesthesia time, the total value should be determined as follows:

Basic Unit Value = 10.0 units 

 First three hours = 12.0 units 

 Subsequent 80 minutes = 8.0 units 

 Total value = 30.0 units 

In both cases, the Maximum Allowable Fee is determined by multiplying the total value units by the Conversion Factor. In billing, list the Basic Unit Value (showing the procedure code and all modifiers) and Time Units separately, as in the following:

Procedure code + Modifier(s) = Basic Unit Value 

 Anesthesia Time = Time Units 

 Total value = Total units 

 Total units x Conversion Factor = Maximum Allowable Fee  

The relative value units for the anesthesia services were excerpted from the 2014 Relative Value Guide, copyright 2013) with permission by the American Society of Anesthesiologists.