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Topic: CMS issues four new payable drug codes

Ambulatory Surgery Reimbursement Update, April 15, 2008

Learn more about this new opportunity for revenue in your ASC

As of January 1, CMS announced four additional C codes payable in the ASC payment system. These include the following:

  • C9237-Injection, lanreotide acetate: Used for patients with carcinoid syndrome. The calendar year (CY) 2008 payment is $24.13.
  • C9240-Injection, ixabepilone: Used for metastatic breast cancer. The CY 2008 payment is $64.54.
  • C9354-Veritas collagen matrix, cm2: Graft that is ideal for soft tissue repairs, with an emphasis on abdominal wall reconstruction. The CY 2008 payment per 2 cm is $11.77.
  • C9355-Neuromatrix nerve cuff, cm: Graft used for dural repair. The CY 2008 payment per cm is $227.26.

However, ASCs should do their homework before reporting the new codes, warns Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, FCS, PCS, a consultant in Maryville, TN. "Just because Medicare will pay for [these drugs] doesn't mean that ASCs should go out and start using them aimlessly," he says. "I can see people starting to charge for these drugs without really demonstrating why they were using these products."

For example, physicians sometimes use veritas collagen matrix in abdominal thoracic wall repairs. When ASCs charge for the product, they need to ensure that the surgeons using these products clearly document the specific graft and the reason they used the veritas collagen in their postop notes.

"From a charging standpoint, it's one thing to charge something correctly, but another thing to have the proper documentation," Krauss says. "If I'm an outside reviewer and I'm validating charges, if I can't find [the drug] on the operative notes, then it's not clear that it was used."

Editor's note: This topic is from the April 2008 issue of Ambulatory Surgery Coding & Reimbursement Insider.

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