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Topic: More pain drugs payable to ASCs

Ambulatory Surgery Reimbursement Update, July 8, 2008

Some of the more commonly used pain drugs that weren’t previously payable to ASCs now are, says Linda Van Horn, MBA, president and CEO of 21st Century Edge in Kansas City, MO. Although most drugs are still bundled, the following drugs are now payable when you report their appropriate J code:

• Baclofen
• Botox
• Myobloc
• Clonidine
• Ziconotide (Prialt)
• Imitrex (if not self-administered)
• Hyalgan
• Supartz
• Synvisc
• Euflexxa
• Orthovisc

Check the CMS Web site. for the current list and reimbursement amounts. Medicare updates the payment amounts quarterly.

As always, watch for common errors when billing drugs. These include basic math errors in efforts to convert the administered dosage to the billing unit quantity, Van Horn says. “Often, physicians will document that a particular drug was injected, but they don’t give the dosage and they don’t document the waste,” she says. “Failure to document and bill for waste is probably the most common error in billing for single-use drugs.”

For single-use bottles, you should select the bottle size that most closely matches the dose to be administered and bill for what is used, as well as the waste. For example, if the physician opens a 40 mg bottle, uses 25 mg, and wastes 15 mg, the ASC can still bill for the entire 40 mg, Van Horn says.

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

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