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Topic: Improve coding ophthalmology at your ASC (part three)

Ambulatory Surgery Reimbursement Update, May 27, 2008

When a party other than an ASC (for example, a surgeon or patient) furnishes an item that a physician uses during surgery, inaccurate coding is a common result and compliance becomes a concern, says Kevin J. Corcoran, COE, CPC, FNAO, president of Corcoran Consulting Group in San Bernardino, CA.

For example, Corcoran describes a case in which an ASC staff member refused to purchase a pharmaceutical required by the surgeon during the procedure because it was costly, so the patient had to furnish that medication at her own expense. Clearly, this presents a compliance problem on many levels.

In another case, the materials manager for an ASC did not want to purchase presbyopia-correcting IOLs, so the surgeon bought the IOLs and charged the patients out of pocket. This created a double-dipping problem because the ASC was reimbursed for a product it did not supply.

“ASCs should not let other people—patients or physicians—bring things in for surgery and charge for items [the ASC] didn’t supply,” Corcoran says. “It is the ASC’s obligation to provide all the supplies for the case, and reimbursement of the claim is based on the stipulation that the ASC did so.”

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

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