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Topic: Note billing changes for infusion pumps

Ambulatory Surgery Reimbursement Update, December 9, 2008

Like spinal cord stimulators, ASCs previously reported device codes when billing for infusion pumps. However, these rules have changed dramatically this year, says Linda Van Horn, MBA, president and CEO of 21st Century Edge in Kansas City, MO.

If the procedure is device intensive (that is, more than 50% of the APC reimbursement amount covers the cost of the device), then Medicare pays ASCs the same amount as a hospital for the device portion of the APC. Medicare discounts the procedure portion of the APC only, Van Horn says.

Under the ASC payment system, ASCs should report the procedure’s CPT code and not report the device code. The allowable for the CPT code contains payment for the procedure and the device.

The example below demonstrates incorrect coding of an implantable programmable pump under the ASC payment system:

Medicare

 

CPT

Charge

Allowable

Payment

Coinsurance

62362

$2,000

$10,157.07

$1,600

$400

C1772

$10,000

$0

$0

$0

Medicare will probably ignore the charge for the device and pay for CPT code 62362 only—in this case, 80% of the lesser of the billed charge or the allowable. Some Medicare carriers will deny the entire claim. Instead, Van Horn says, leave off the device code and bill the procedure as follows:

Medicare

 

CPT

Charge

Allowable

Payment

Coinsurance

62362

$12,000

$10,157.07

$8,125.66

$2,031.41