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Topic: Evaluate inclusion of new orthopedic procedures

Ambulatory Surgery Reimbursement Update, June 10, 2008

The new ASC payment system bundles many orthopedic services that had previously been separately payable, and allows some separate payments for ancillary services that were once packaged. In an April 2 HCPro audioconference, "ASC Orthopedic Changes: Confront Coding and Financial Repercussions of the Final Rule,"Susan Garrison, PCS, FCS, CPC, CHC, CCS-P, CPC-H, CPAR, executive vice president at Magnus Confidential, Inc., in Dawsonville, GA, described how to determine which procedures you should add to your facility's services in consideration of the changes.

The payment indicator determines how Medicare reimburses for individual CPT orthopedic codes. ASC coding and billing staff members must strive to understand those payment indicators, link them to the codes that they bill, and determine what that means for the bottom-line revenue, said Garrison. Procedures in orthopedics that have payment indicators G2, P2, P3, or R2 are all procedures that Medicare would not pay ASCs to perform before this year. Take into account different aspects of performing the procedures to evaluate whether you will introduce them into your service mix.

Consider the following:

  • Does the payment rate justify any changes you might have to make, such as to your equipment or your operating room?
  • Will you have to add physicians with certain specialties for these types of procedures?
  • Do you think your volume will offset any costs to initiate new procedures that reimburse for less so that they are winners for you?

"You really have to do an in-depth analysis," Garrison says. "You need to know what you are good at now and what you can perform efficiently before you expand your services."

Editor's note: This topic is from the June 2008 issue of Ambulatory Surgery Coding & Reimbursement Insider. For more information about the April 2 audioconference, "ASC Orthopedic Changes: Confront Coding and Financial Repercussions of the Final Rule," click here.

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