Ob-Gyn Coding Alert

Reader Question:

Surgical Trays

Question: Does Medicare pay for gynecological surgery trays? Where can I find the latest information on this policy?

Florida Subscriber

Answer: Medicare's policy on surgical trays was printed originally in the Nov. 2, 1998, Federal Register under, "Additional Relative Value Units for Additional Office-Based Expenses for Certain Procedure Codes." This policy excerpt explains that although Medicare used to pay for surgical supplies with certain in-office procedures, it no longer does.

"Usually office medical supplies or surgical services in the physician's office are included in the practice expense portion of the payment for the medical or surgical service to which they are incidental. The November 1991 final rule (56 FR 59522) included a policy for 44 procedure codes that allowed a practice expense RVU [relative value unit] of 1.0 to pay for the supplies that are used incident to a physician's service but generally are not the type of routine supplies included in the practice expense RVUs for specific services. This list of procedure codes was expanded in the December 1993 final rule (58 FR 63854) We proposed to revise this policy under the resource-based practice expense system. We believe the supply costs that this policy is designed to cover were included in the supply inputs identified by the CPEPs [Clinical Practice Expert Panels] and the AMA's SMS [senior medical student] survey. Thus, they were included in the practice expense RVUs for each relevant procedure code. Therefore, we propose to discontinue separate payment for supply codes A4263, A4300, A4550, and G0025."

Notably, the RBRVS [resource-based relative value scale] database no longer has a site-of-service differential column, which is where the information about coding for surgical trays had been noted when it was being paid. Also, the status for A4550 (Surgical trays) is now I, which means Medicare uses another code for the reporting of these services. The status code for A4550 also appears to have changed to B, which means "bundled." This information is contained in transmittal memo AB-01-177, dated Dec. 11, 2001.

Because CMS stated this would be their policy, all the evidence so far seems to indicate they implemented it.

Advice for You Be the Coder and Reader Questions was provided by Melanie Witt, RN, CPC, MA, an ob/gyn coding expert and educator who lectures nationally on Medicare coding and reimbursement.