HCPro.com: Ambulatory Surgery Coding & Reimbursement Insider

Each month in Ambulatory Surgery and Compliance Reimbursement Insider you get more of our exclusive working tools: model guidelines, policies, forms, etc., that you can use to comply with OIG and HCFA, reduce claim denials, and get paid in full and on time.

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June 2008 (Volume 5, Issue 6)	view entire issue

Take a closer look at new orthopedic procedures
The inclusion of several orthopedic procedures to the ASC-approved list brings with it the opportunity for additional and missed reimbursement. This change is a concern if your clinical staff members are not used to documenting these procedures and your coding and business staff members are not used to coding and billing for them, Christi Sarasin, CCS, CPC-H, FCS, a consultant and CEO of Sarasin Consulting Group in Friendship, MD, said in an April HCPro, audioconference, "ASC Orthopedic Changes: Confront Coding and Financial Repercussions of the Final Rule."

Educate and reeducate physicians on documentation
Complete and accurate coding hinges upon complete physician documentation. Physicians must document all the necessary details so that ASCs can bill for primary procedures, as well as any other secondary procedures that a surgeon performs. However, physicians often omit these critical facts from their documentation, and this ultimately delays reimbursement because coders have to engage in a back-and-forth query process with physicians to obtain the information they need.

Offset lower phase-in payments with enhanced service mix
For procedures that have significant device components, but whose devices may not be so expensive as to qualify for device-intensive status, the phase-in policy for the new ASC payment system compromises their profitability-and possibly threatens their viability in the short term. For example, a physician performs a glaucoma procedure aqueous shunt to extraocular reservoir (code 66180) because medical treatment for the glaucoma patient is no longer effective and the standard trabeculectomy is not indicated or has failed. Due to the patient's condition, the physician inserts a shunt to relieve intraocular pressure.

Understand the new cholecystectomy procedures
Starting this year, Medicare has approved a broader base of patients upon whom ASCs can perform laparoscopic cholecystectomy (lap chole) procedures. Now that Medicare is covering additional lap chole procedures for ASCs, surgery centers can perform additional procedures or add lap chole procedures as a new offering if they previously did not perform them. Report these new procedures using codes 47562, 47563, and 47564.

Other recently-published articles from Ambulatory Surgery Coding & Reimbursement Insider:

Billing rules for devices can be different for each payer

Ambulatory Surgery Coding & Reimbursement Insider 2008 index

Medicare modifiers for ASCs

ASC tackles CFCs to avoid tumult in the future

Be a G whiz: Understand when to assign G codes

Medicare modifiers for ASCs: -50, -52, -58, and -59

Tips to tackle five ASC operational challenges

Understand the billing methods for different types of lenses

Check up on ASCs under the 2008 Medicare payment system

Choose the correct code when reporting SI joint injections

Implement a payment policy and stick to it

Don’t shoot your finances in the foot

ASC 2009 proposed rule holds few surprises

Tackle 12 important medical record documentation issues

Take caution with out-of-network billing strategies

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