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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September 2008 (Volume 5, Issue 9)	view entire issue

ASC 2009 proposed rule holds few surprises
Many in the ASC community were relieved to learn that the fiscal year 2009 ASC proposed rule held few, if any, surprises. The proposed rule, which was released July 3, continues the move to the new ASC payment rates, with ASC services paid at a 50/50 blend of the 2007 ASC payment and the 2009 ASC payment (i.e., 65% of the hospital outpatient rate). The update to ASC rates marks the second year of a four-year transition to align these rates with those paid to HOPDs and minimize the effect of financial incentives on decisions about treatment settings, the proposed rule states.

Don't shoot your finances in the foot
Coding for podiatry can be fairly complicated due to the number of procedures that may be involved in one case, says Lowell Scott Weil Sr., DPM, FACFAS, chair and CEO of Weil Foot & Ankle Institute and Foot & Ankle Surgery Center in Des Plaines, IL. Sometimes, those multiple procedures are lost in coding because the coders use the wrong modifier. And that may mean you are leaving money on the table. Examine use of modifier -59, T modifiers Modifier -59 and T modifiers, in particular, are often misused and lead to incorrect coding.

Implement a payment policy and stick to it
The best way to prepare your staff members to handle patient requests for payment arrangements is to have a thorough policy in place. With a strong policy, your staff members will know how to manage these situations, and they can show the policy to your patients to help explain the restrictions of the arrangements. "An ASC has to have a policy where it's clearly written exactly what you can and can't do so your staff can defend it," says Sandy Berreth, BS, RN, MS, CASC, administrator at Brainerd Lakes Surgery Center in Baxter, MN.

Choose the correct code when reporting SI joint injections
When coding sacroiliac (SI) joint injections, ASC coders are frequently faced with a quandary about which code to use. The coding choices are CPT codes 27096, G0260, and 20610-but what is the difference between the codes, and under which circumstances should you report them? Learn the code definitions The best starting point on the path to the right code is learning the definitions for the three CPT codes: 27096-Injection procedure for sacroiliac joint arthrography and/or anesthetic/steroid G0260-Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography 20610-Injection; major joint or bursa

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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