Otolaryngology Coding Alert

We made it easy to compare costs on 37 now-ASC-eligible -office- procedures Your practice might be able to benefit financially from moving certain office or hospital procedures to an ambulatory surgical center (ASC). Although most otolaryngology coders mainly deal with outpatient and inpatient services, you might sometimes code for ENT surgeries performed in an ASC, making this location's unique coding rules important to you. For instance, "Action Medical bills for three surgery centers," says one of its billing specialists in Irvine, Calif. And while BergerHenry ENT Specialty Group's five-physician, five-office, five-facility practice performs the majority of its procedures in the outpatient setting, it uses one ASC, says Ginny McManus, billing manager for the New Jersey practice. News: 2008 marks a world of change to the ASC coding and payment system. CMS added 790 procedures to the ASC-approved list. Identify your top relocation candidates after getting acquainted with these basics. Exclude Only High-Risk, Overnight Procedures From ASC CMS used to indicate which surgeries it would pay for performing in an ASC (place-of-service code 24) with a list of included codes. In 2008, the payment system is instead exclusionary-based. Medicare chose specific criteria for which it will exclude a procedure from eligibility for ASC performance, says Susan Garrison, PCS, FCS, CCS-P, CHC, CPC, CPC-H, CPAR, executive vice president of Magnus Confidential Inc. in Atlanta. "CMS will exclude a procedure from the ASC list if the procedure: - poses a significant safety risk to the beneficiary - would result in the patient usually requiring active medical monitoring and care after midnight following the procedure - is on the inpatient-only list - directly involves major blood vessels - requires major or prolonged invasion of body cavities - generally results in extensive blood loss - is emergent in nature - is life-threatening in nature - commonly requires thrombolytic therapy - can only be reported using an unlisted surgical procedure code." Expect 33% Less at ASC Than at POS 22 The hospital Outpatient Prospective Payment System (OPPS) will serve as the basis for the new ASC reimbursement system. Both outpatient hospitals (POS 22) and ASCs "will be paid under Ambulatory Payment Classifications (APC), but with different allowed amounts than hospital outpatients," Garrison says. CMS will pay an ASC-performed surgical procedure about 67 percent of the OPPS rate. The reduction makes sense. Hospital outpatient departments have higher operating costs than ASCs, says Annette Grady, CPC, CPC-H, CPC-P, CCS-P, executive officer of the American Academy of Professional Coder's National Advisory Board. Hospital outpatient facilities have to incur additional costs, such as providing 24-hour operations and enduring more intense monitoring with certification issues. Plus, "they have more acute type care available and are required to treat patients that do [...]