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Ambulatory Surgery Reimbursement Update

Ambulatory Surgery Regulation Update is a weekly e-mail newsletter that offers news and stories about regulatory issues in ambulatory surgery, like certificate of need legislation and physician ownership issues, presented in a "quick-read" format. You'll also receive links to industry reports as available.

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Ambulatory Surgery Reimbursement Update

Issue 50, December 18, 2007

• New York ASCs cost taxpayers $8 million

  New York's state comptroller released a press statement December 3, which detailed shocking news...

• Coding tip: Understand functional rhinoplasty procedures

  Base correct reimbursement for functional rhinoplasty procedures on proper coding and documentation...

• New Jersey ASCs face danger due to Codey ruling

  The Codey Act (N.J.S.A. 45:9-22.5), a November 20 ruling, may jeopardize the vitality of New Jersey...

• See you in 2008!

  Editor's note: The next issue of Ambulatory Surgery Reimbursement Update will be on January 8...

Issue 49, December 11, 2007

• Organization members approve FASA and AAASC merger

  Both the American Association of Ambulatory Surgery Centers (AAASC) and the Federal Ambulatory...

• Coding tip: Know your nose anatomy

  Before you can code ear, nose, and throat (ENT) procedures, you should know the relevant anatomy...

• Pennsylvania report shows state ASCs, acute-care hospitals net patient revenue

  The Pennsylvania Health Care Cost Containment Council, an independent agency across northwestern...

Issue 48, December 4, 2007

• Johnson & Johnson to create new medical device units despite other woes

  Johnson & Johnson recently announced that it will create two new medical device units (surgery...

• Coding tip: Deep vs. superficial pin removal

  You would code procedure codes for the removal of internal fixation devices, screws, wires, and...

• APCs survey: Your feedback is important

  Your feedback is the most important tool we have. Please help us meet your needs by completing a...

Issue 47, November 27, 2007

• CMS directs state Medicare surveyors to delay Medicare applicant surveys

  CMS issued a memorandum earlier this month that cited both an increase in the number of new...

• Coding tip: Know your integumentary system coding definitions

  Lesion excisions: An excision is a full-thickness (through the dermis) removal of a lesion, and...

• Don't miss AAASC's updated Medicare ASC payment calculator

  The American Association of Ambulatory Surgery Centers (AAASC) updated its calculator to forecast...

Issue 46, November 20, 2007

• Watch out for new anti-markup rules

  CMS released its 2008 Medicare Physician Fee Schedule (MPFS), which included new anti-markup rules...

• Coding tip: Update your coding resources

  It's that time again. It's time to order new coding books for 2008. It is very important to...

• AAO reports ophthalmology advances for 2008

  The American Academy of Ophthalmology (AAO) reports that despite the 10.1% cut in the 2008 Medicare...

• Take the latest ASCRI benchmarking survey today!

  Dear ambulatory surgery coding professional: Ambulatory Surgery Compliance & Reimbursement...

Issue 45, November 13, 2007

• Final ASC Medicare payment rates released November 1

  The Centers for Medicare & Medicaid Services (CMS) released its combined final outpatient...

• Coding tip: Note the three types of skin grafts

  Code skin graft procedures based on the type of graft used and the recipient site.

• Five implant manufacturers post consulting payment amounts on Web sites

  Implant manufacturing companies Zimmer, DePuy, Biomet Orthopedics, Smith & Nephew, and Stryker...

Issue 44, November 6, 2007

• Contact your U.S. Senator today!

  Senator Mike Crapo (R-ID), introduced the Ambulatory Surgical Center Medicare Payment Modernization...

• Coding tip: Understand breast biopsy types

  Breast excision codes are unilateral codes that require bilateral modifiers (modifier -50, modifier...

• GA general surgeons may be exempt from CON

  Georgia's Department of Community Health (DCH) gave first round approval to exempt general surgeons...

Issue 43, October 30, 2007

• OIG plans to review ASC procedures, policies for 2008

  The Department of Health and Human Services' (HHS) Office of Inspector General (OIG) released its...

• Coding tip: Determine active versus chronic tears in order to code rotator cuff tears

  Shoulders are subject to a lot of wear and tear and/or degeneration, due to the constant use of our...

• Study proves laparoscopic cholecystectomies safe in ASCs

  Dartmouth-Hitchcock Medical Center presented a study at the American College of Surgeons' (ACS...

Issue 42, October 23, 2007

• MLN Matters article released on NPI rejection

  CMS recently released a special edition MLN Matters article (Number SE0744) that outlines what to...

• Know the difference between a capsulotomy and reanalysis

  Per the CPT Assistant of March 2003, a capsulotomy is performed on the joint in an attempt to...

• Physician rates maybe be cut by 10% due in part to ASCs

  Medicare premiums for outpatient services will increase by only 3.1%, while physician rates will be...

Issue 41, October 16, 2007

• FASA and AAASC to merge

  Over the last five months, leaders of both the American Association for Ambulatory Surgery Centers...

• Coding tip: Learn types and names of bunion procedures, part 2 of 2

  It is very important to know the type of procedure performed, and to verify its components before...

• OOSS provides cataract benchmarking survey

  The Outpatient Ophthalmic Surgery Society (OOSS) released its benchmarking ophthalmology survey...

Issue 40, October 9, 2007

• Physicians may face more transparency concerns

  U.S. District Judge Emmet G. Sullivan ordered the Department of Health and Human Services (HHS...

• Coding tip: Learn types and names of bunion procedures: Part 1

  The type and name of the bunion procedure is very important information for the surgeon to indicate...

• Study refutes mammoplasties as non-covered procedures

  The journal Plastic and Reconstructive Surgery published a study September 15 that refutes the fact...

Issue 39, October 2, 2007

• Hospitals see volume decrease from ASC competition

  Inquiry, a journal published by Excellus Blue Cross Blue Shield in Rochester, NY, published a study...

• Coding tip: Understand essential fracture information

  Coders code fractures of specified sites individually by site in accordance with both the...

• Stark II Phase III final rule lacks ASC news

  CMS released the Stark II Phase III final rule September 5 in the Federal Register, but...

Issue 38, September 25, 2007

• AAASC rallies support during Washington Leadership Conference

  The American Association of Ambulatory Surgery Centers (AAASC) hosted its leadership conference...

• Coding tip: Know distinctions between types of synovitis

  The word synovium comes from the Latin word meaning "with egg". The synovial fluid in the joint is...

• FASA offers ASC quality reporting comments to Medicare

  The Foundation for Ambulatory Surgery in America (FASA) submitted its comments to Medicare on...

Issue 37, September 18, 2007

• GAO report finds some private insurers' payments are higher than Medicare's

  The Government Accountability Office (GAO) recently released a report that indicated Medicare's...

• Coding tip: Be aware of primary versus secondary neoplasms

  There are certain neoplasms that you should automatically assume are secondary (metastatic...

• Medicare providers should only reply on their contractors for NPI implementation schedules

  CMS learned August 6 that an unnamed trade publication recently published an inaccurate schedule of...

Issue 36, September 11, 2007

• CMS updates ASC payment information for value-drive healthcare

  CMS published a list of last year's ASC data August 29, according to the CMS Web site. This cost...

• Coding tip: Modifiers in general

  Modifiers are extremely important and can have a significant impact on the ASC's reimbursement.

• Maryland rules supreme in number of ASCs

  To date, Maryland has the highest number of ASCs in the nation, according to The Foundation for...

Issue 35, September 4, 2007

• CMS announces proposed conditions of coverage rule for ASCs

  CMS issued a proposed rule August 24 that, if passed, will update the existing Conditions for...

• Coding tip: Code modifier -GY to indicate a non-covered service

  Editor's note: Due to an editing error in today's issue of Ambulatory Surgery Reimbursement Update...

• Editor's note: Correction to this week's coding tip

  Editor's note: Due to an editing error in today's issue of Ambulatory Surgery Reimbursement Update...

• AHA criticizes CMS' ASC list of approved procedures

  The American Hospital Association (AHA) published a Regulatory Update August 23, which criticized...

Issue 34, August 28, 2007

• Georgia docs voice their ASC concerns

  Drs. Stephen Finn and George Goldin discussed concerns about a proposed cut in national...

• Coding tip: Understand the use of modifier -58 in your ASC

  What does modifier -58 mean for your ASC facility? It means that your physician may need to...

• Don't miss your chance to take the ASCRI reader survey!

  Your feedback is the most important tool we have. Please help us meet your needs by taking our...

Issue 33, August 21, 2007

• Cataract procedures to see increased payments in 2008

  Under the new ASC payment system, Medicare reimbursement for ophthalmic surgical procedures will...

• Coding tip: Properly code the X-STOP procedure for spinal stenosis of the lumbar spine

  The X-STOP procedure, which the FDA approved in November 2005, is an interspinous process...

• NPI Registry to commence in September

  CMS plans to release National Plan and Provider Enumeration System (NPPES) provider data via the...

Issue 32, August 14, 2007

• American College of Gastroenterology predicts new payment rate to devastate GI services

  The American College of Gastroenterology (ACG) predicts that GI ASCs will take a particularly hard...

• Coding tip: Know when you can bill for tendon grafts with ACL repair procedures

  You usually can't bill for tendon grafts when used for arthroscopic ACL repairs. However, under...

• CMS proposes surety bond requirement for DMEPOS suppliers

  CMS issued a proposed durable medical equipment (DME) rule that would require all Medicare...

Issue 31, July 31, 2007

• FASA provides Medicare rate calculator

  If you're wondering how to calculate your Medicare payment for local areas for procedures on...

• CHAMP self-referral ban may hit physician owners

  Under the proposed Children's Health and Medicare Protection Act (CHAMP), which Congress released...

• Coding tip: Code epidural steroid injections by region of single injection

  Bill epidural steroid injections (ESIs) using CPT code 62310, which pertains to the...

• Coding tip: Know what the "global package" includes and excludes for spinal procedures

  The following items are not billable: SSEP monitoring (CPT code 95920) Placement of cranial...

• AAASC creates payment rule discussion group

  The American Association of Ambulatory Surgery Centers (AAASC) created a 2008 Medicare ASC payment...

• Take action: Ask your U.S. Representative to support your ASC

  The American Association of Ambulatory Surgery Centers (AAASC) urges you to contact your U.S...

Issue 30, July 24, 2007

• CMS revamps ASC payment system, Medicare-approved procedure list for 2008

  The Centers for Medicare & Medicaid Services (CMS) issued its final rule July 16 outlining a...

• Coding tip: Use modifier -59 accurately to avoid an unwanted audit

  Use modifier -59 to indicate that the physician performed a procedure or service which was distinct...

• CMS takes initial steps toward paying for encounters, not services

  CMS is "proposing to view a service, in some cases, as not just the diagnostic or treatment...

• CMS to hold special ASC open door forum

  CMS will hold a special open door forum July 31 from 2:00 p.m. to 3:30 p.m. EDT on the revised ASC...

Issue 29, July 17, 2007

• CMS may excuse e-prescribing, computer-generated fax exemption

  CMS issued a proposed Medicare Physician Fee Schedule (MPFS) June 29 which included a provision...

• Coding tip: Code biomechanical implants per intervertebral space

  When you code biomechanical implants, keep in mind that CPT code 22851, used for the application of...

• Calling all confused coders!

  Are you baffled by a particular ASC coding question? Are you seeking reliable answers?

• HHS fights for DME fraud protection

  Mike Leavitt, secretary for the Department of Health and Human Services (HSS), announced July 5 a...

Issue 28, July 10, 2007

• AAAHC releases seven new benchmarking studies

  The AAAHC Institute for Quality Improvement (AAAHC Institute) released seven new reports that offer...

• Coding tip: Code spinal stenosis based on level or region of spine

  Stenosis is the constriction or narrowing of a duct or passage in the spine, and it can produce...

• CMS proposes policy, payment changes for physician services in 2008

  CMS released a proposed rule that would revise payment rates and policies under the Medicare...

• CMS delays NPPES release

  CMS delayed NPI dissemination for an additional 30 days after the publication of the notice...

Issue 27, July 3, 2007

• California Assembly passed bill to amend Health and Safety Code

  With help from the California Ambulatory Surgery Association (CASA), the California Assembly passed...

• Coding tip: Understand the different degenerative disc diseases

  You might think that the term degenerative means that certain symptoms will worsen with age. The...

• TASCS helps defeat two bills that would affect physician ownership of ASCs

  The Texas ASC Society's (TASCS) lobbying efforts paid off as it was able to help defeat two bills...

• Brookwood's Vestavia project encounters resistance

  HealthSouth Corporation, Birmingham Surgery Centers, and St. Vincent's hospital, all located in...

Issue 26, June 26, 2007

• HIDA releases 2006-2007 ASC market report

  The Health Industry Distributors Association (HIDA) released their 2006-2007 ASC market report June...

• Coding tip: Use synovectomy codes for plica syndrome

  Plica Syndrome is a condition involving extra folds of material which normally help reduce friction...

• OIG releases advisory opinion on ASCs, physician investors

  The Department of Health and Human Services Office of Inspector General (OIG) posted a new advisory...

Issue 25, June 19, 2007

• Retail Health Care Facility Permit Act takes next step toward approval

  The Illinois General Assembly re-referred Bill 1885, known as the Retail Health Care Facility...

• Coding tip: Understand the three categories of repair codes

  Repair codes in the 10000 section are divided into three categories: simple, intermediate and...

• CMS updates PQRI measure specs

  The Centers for Medicare & Medicaid Services (CMS) announced that they have updated their 2007 list...

Issue 24, June 12, 2007

• OMB reviews new ASC payment system, CfC criteria

  The White House Office of Management and Business (OMB) is presently reviewing rules covering the...

• Coding tip: Follow an appropriate diagnosis coding process

  Have you ever experienced a "medical necessity" claim denial? Medicare and other payers frequently...

• CMS to terminate UPIN assignment

  CMS announced that it will discontinue assigning Unique Physician Identification Numbers (UPIN...

Issue 23, June 5, 2007

• CMS releases NPPES data dissemination notice

  CMS released their National Plan and Provider Enumeration System (NPPES) Data Dissemination Notice...

• Coding tip: Use proper diagnosis codes

  Medicare's Local Medical Review Policies (LMRP), Local Coverage Determinations (LCD), or National...

• Industry News: AAASC announces new directors and officers

  The American Association of Ambulatory Surgery Centers (AAASC) announced its new board of director...

• NovaMed acquires second ASC in Michigan

  NovaMed, Inc. acquired a 62.5% interest in the Surgery Center of Kalamazoo in Portage, MI...

Issue 22, May 29, 2007

• Three physicians face felony charges for unnecessary procedures at Santa Ana ASC

  Doctors Michael C. Chan, William W. Hampton Jr., and Mario Z. Rosenberg each face 47 felony charges...

• Coding tip: Correctly sequence CPT codes on claim forms

  You should sequence CPT codes on Medicare claims from highest to lowest payment groupings.

• Human Services Committee set to hear Illinois licensing bill

  The Illinois Senate Public Health Committee revised and approved bill (SB 243) May 14, which would...

Issue 21, May 22, 2007

• CMS could identify inefficient physicians by mid-2008

  CMS may have the ability to identify and target inefficient physicians by mid-2008, according to...

• Coding tip: Recognize most common revenue codes

  You use revenue codes (also known as "REV" codes) on UB claim forms and place them in field locator...

• NQF endorses additional consensus standards for ambulatory care

  The National Quality Forum (NQF) declared its endorsement of further clinician-level national...

• CMS issues memorandum for ASC backup power requirements

  Under certain circumstances, ASCs are allowed to use batteries for backup power, according to a new...

Issue 20, May 15, 2007

• Senate could deny payments to physicians owing taxes

  Physicians who owe federal taxes, but who still receive federal funds through Medicare, may face...

• Coding tip: Watch for different codes for SI joint injections

  Sacroiliac joint injections, also known as "SI joint injections," are injections of...

• CMS confirms implementation date for UB-04 claim form

  CMS has confirmed that its strict deadline for the UB-04 implementation date will in fact be May...

Issue 19, May 8, 2007

• ASCs can now provide A-C IOLs for Medicare recipients

  CMS released a new administrator ruling on April 27, which allows ASCs to provide...

• Coding tip: Correctly code new vertebroplasty procedures

  Percutaneous vertebroplasty procedures (codes 22520, 22521, and 22522) were added to the Medicare...

• Don't miss CMS' roundtable on the NPI contingency plan!

  CMS will hold a roundtable discussion on the Medicare Fee for Service (FFS) national provider...

Issue 18, May 1, 2007

• HHS provides Web site on HIPAA privacy rule

  The Department of Health and Human Services (HHS) released information on their latest Web site...

• Coding tip: Let technique drive colonoscopy code selection

  Coding colonoscopies may be difficult due to variable physician documentation.

• MASCA members receive NPI information

  The Missouri Ambulatory Surgery Center Association (MASCA) held an educational presentation on the...

• Cardiologists, orthopedic surgeons generate an average of more than $2.3 million

  A new survey reveals that cardiologists and orthopedic surgeons generate the most in net revenue...

Issue 17, April 24, 2007

• CMS provides NPI contingency plan FAQ

  The Centers for Medicare & Medicaid Services (CMS) posted a FAQ section on their Web site April 11...

• Coding tip: Correctly code lumbar discography

  A physician performs a discography procedure to assess the level of damage to a herniated disc...

• FDA seizes all implantable devices from Shelhigh, Inc.

  The U.S. Food and Drug Administration (FDA) seized all implantable medical devices April 17 from...

Issue 16, April 17, 2007

• Vermont eye center likely to receive CON; health centers voice disappointment

  A new South Burlington, VT eye surgery center will likely receive a certificate of need (CON) from...

• Coding tip: Use correct fluoroscopic guidance codes

  The fluoroscopic guidance codes 76003 and 76005 were deleted from the CPT manual as of December...

• National ASC Open House Day is August 15

  This year's National ASC Open House Day will take place August 15, according to the FASA Web site.

Issue 15, April 10, 2007

• CMS grants some leniency for NPI implementation

  The Centers for Medicare & Medicaid Services (CMS) announced April 2 that it will not implement the...

• Coding tip: Code properly for open arthroscopic procedures

  If you start a surgical procedure as an arthroscopic procedure and are not able to complete it...

• Colorado bill calls for simplicity in insurance contracts

  The governor of Colorado has signed a bill that requires standardized language in contracts between...

Issue 14, April 3, 2007

• ASC Medicare Payment Modernization Act introduced

  A new ambulatory surgery center (ASC) payment system proposal was introduced by House...

• Review EOBs for denial reasons

  If you regularly review explanations of benefits (EOB) for denial reasons, they will provide you...

• CMS-1500 deadline extended due to incorrectly formatted form

  CMS reported that the new CMS-1500 form, most commonly known as the 08-05, is incorrectly formatted...

• FREE ASC benchmarking report (one week left)

  This is the final week you can participate in the latest Ambulatory Surgery Compliance...

• Bills to change Georgia's CON law fail to pass

  Bills that would have altered Georgia's certificate of need (CON) law failed to pass through the...

Issue 13, March 27, 2007

• Patients' surgery decisions are based on physicians' preferences

  Although most patients are involved in choosing where they have major surgery, many leave the...

• Coding tip: Make sure to refund credit balances

  Be sure to keep up to date with the credit balances your facility owes and to refund them in a...

• Covered entities face HIPAA security audits

  The Office of Inspector General (OIG) says it is in the process of conducting HIPAA audits of...

• Private investment partnership to acquire HealthSouth surgery division

  HealthSouth Corp. (HLS) announced that it will sell its surgery division to TPG Inc., according to...

Issue 12, March 20, 2007

• Bausch & Lomb lenses receive NTIOL designation

  Bausch & Lomb announced the Centers for Medicare & Medicaid Services designated two of its...

• Coding tip: Billing for new procedures

  When you add new technology or new procedures at your facility, beware of coding advice from...

• Profiling physicians may help identify inefficiencies, says GAO

  The Government Accountability Office (GAO) recommended that the Centers for Medicare & Medicaid...

• Connecticut physicians may see 3% revenue tax

  Lawmakers in Connecticut are weighing a 3% tax on physicians' revenues, according to the Hartford...

Issue 11, March 13, 2007

• FASA, ASC leaders present views about proposed Medicare changes to CMS and HHS

  FASA's 2007 Legislative and Compliance Seminar provided an opportunity for FASA leadership and...

• Coding tip: Coding an unlisted arthroscopic procedure

  When a surgeon performs a procedure arthroscopically and you don't see a specific code in the...

• Outpatient surgery dominates eye surgery, muscle and tendon procedures

  Almost 97 percent of cataract and lens procedures were performed at outpatient centers, making...

Issue 10, March 6, 2007

• CMS considers substantial revisions to ABN forms

  The Centers for Medicare & Medicaid Services (CMS) published in the February 23 Federal Register a...

• Coding tip: Be wary of fraud and abuse

  What's the difference between fraud and abuse? Intent!

• CON debate heats up in Georgia's General Assembly, media coverage

  The debate over whether Georgia's Certificate of Need (CON) is necessary continued over the past...

• Coming in the next issue of Ambulatory Surgery Reimbursement Update. . .

  FASA hosted a meeting at its national office with Acting Deputy Administrator Herb Kuhn, Health and...

Issue 9, February 27, 2007

• Medicare to provide physician performance information

  Medicare beneficiaries will soon have access to physician performance data following the...

• Coding Tip: Code the body of operative reports

  For coding surgical cases, be sure to read the ENTIRE operative report before coding surgical...

• PHA requests emergency and patient disclosure policies

  The executive director of Physician Hospitals of America (PHA), formerly the American Surgical...

Issue 8, February 20, 2007

• Bush proposes reduction in ASC inflation increase

  President Bush proposed to reduce the inflation increase for ambulatory surgery centers (ASC) by...

• Coding tip: ’Always’ bill for implants

  Is your facility leaving money on the table by not billing for implants used in surgical cases?

• PHA defends industry following patient death

  Physician Hospitals of America (PHA), formerly the American Surgical Hospital Association, issued a...

Issue 7, February 13, 2007

• AAASC develops searchable directory of ASCs by Congressional district

  The American Association of Ambulatory Surgery Centers (AAASC) developed a searchable spreadsheet...

• Vermont closer to first freestanding ASC

  The proposal for an ambulatory eye surgery center received approval last week for the center to...

Issue 6, February 6, 2007

• GI reimbursement would take major hit under CMS proposed rule

  Ambulatory surgery centers performing gastrointestinal (GI) procedures could face serious financial...

• Coding tip: Review Medicare Bulletins

  The information in Medicare Bulletins isn't just for physicians-surgical facilities should review...

• Industry News: ASC operator accepts takeover offer

  Triad Hospitals Inc., which operates 13 ASCs and 54 hospitals, accepted Monday a $4.7 billion...

Issue 5, January 31, 2007

• Medicare to cover astigmatism-correcting lenses

  The Centers for Medicare & Medicaid Services (CMS) is permitting astigmatism-correcting lenses as...

• Bill would require ASCs to address assaults of employees

  A bill introduced earlier this month in the Oregon Legislative Assembly would require healthcare...

• Survey: Americans want electronic access to medical records

  Americans want to have electronic copies of their medical records and believe having greater access...

Issue 1, January 2, 2007

• Pennsylvania remains hotbed for ASC v. hospital conflict

  The Hanover, PA-based Evening Sun is the latest publication to cover the issue of ambulatory...

• AHRQ creates database for geographic insurance-cost comparison

  A new federal database created by the Agency for Healthcare Research and Quality (AHRQ) allows...

• FASA requests board nominations

  FASA (formerly the Federal Ambulatory Surgery Association) is seeking nominations of individuals to...