ASCs Begin Quality Reporting in October

The time is near when ambulatory surgical centers (ASCs) join the ranks of facilities required to participate in a federally mandated quality reporting program. Beginning with dates of service on or after Oct. 1, ASCs will be required to report five claims-based quality measures. ASCs failing to comply will incur a 2 percent reduction in their ASC annual payment update beginning in 2014.

Quality measure descriptions and related HCPCS Level II codes required to be submitted on the ASC Part B CMS-1500 claim form with a zero charge beginning Oct. 1 are as follows:

Ambulatory Surgical Center CASCC

Description HCPCS Level II Codes
1. Patient burn (Unintended tissue injury caused by scalds, contact, fire, chemical, electrical, or radiation) G8908 Patient documented to have a burn prior to discharge
G8909 Patient documented not to have received a burn prior to discharge
2. Patient fall (ASC admissions experiencing a fall within the confines of the ASC) G8910 Patient documented to have experienced a fall within the ASC
G8911 Patient documented not to have experienced a fall within the ASC
3. Wrong site, side, patient, procedure, or implant (Not in accordance with intended site, side, patient, procedure, or implant) G8912 Patient documented to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event
G8913 Patient documented not to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event
4. Hospital admission/transfer (Any transfer/admission from an ASC directly to an acute care hospital, including hospital emergency room) G8914 Patient documented to have experienced a hospital transfer or hospital admission upon discharge from ASC
G8915 Patient documented not to have experienced a hospital transfer or hospital admission upon discharge from ASC
5. Prophylactic IV antibiotic timing (All ASC admissions with a preoperative order for a prophylactic IV antibiotic for prevention of surgical site infection) G8916 Patient with preoperative order for IV antibiotic surgical site infection (SSI) prophylaxis, antibiotic initiated on time
G8917 Patient with preoperative order for IV antibiotic surgical site infection (SSI) prophylaxis, antibiotic not initiated on time
G8918 Patient without preoperative order for IV antibiotic surgical site infection (SSI) prophylaxis

ASCs should report measure code G8907 Patient documented not to have experienced any of the following events: a burn prior to discharge; a fall within the facility, wrong side, wrong patient, wrong procedure or wrong implant event; or a hospital transfer or hospital admission upon discharge from the facility when the patient did not experience the first four events. You cannot report G8907 with any of the first four measure codes.

For 2015, ASCs will be required to report in 2013 the same five quality measures, plus two structural measures (surgical procedure volume and safe surgery checklist use); and in 2016, ASCs will report in 2014 those seven quality measures plus one process of care measure (influenza vaccination among health care workers).

This last measure is sure to put salt in an old wound. During the H1N1 epidemic, several states and health care facilities tried to make it mandatory for health care workers to be vaccinated. They encountered much resistance, and eventually gave up the ship. To tie vaccination to payment will surely bring further heated debate.

For additional information regarding the ASC quality reporting program, refer to CMS’ ASC Quality Reporting Specifications Manual.

Source: TrailBlazer

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One Response to “ASCs Begin Quality Reporting in October”

  1. Bobbi Cook says:

    The description for G8918 is incorrect. It should read, “Patient WITHOUT preoperative order…” This is misleading and has caused us to not report any of the antibiotic codes. At least one antibiotic code must be reported in order to get credit for the quality reporting.

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