Wiki ASC, implants & Medicare

[HollyBrosz]

Morning - I am wondering if someone could answer this Ambulatory Surgery Center question for me.

When a total joint arthroplasty (27447/27130/23472) is performed on a Medicare patient are you also billing a separate line with C1776 for the implant along with the primary procedure? If so, is Medicare reimbursing you or are they denying C1776 as included in the primary procedure?

Thank you in advance!
Holly

 

[haraml7]

what is your status indicator for the C1776 in the HCPCS book? This would follow the OPPS guidelines correct?

 

[HollyBrosz]

It looks like it has the N indicator... Also on the CMS website I did find a spreadsheet and that one had the indicator as N1.

 

[haraml7]

It looks like it has the N indicator... Also on the CMS website, I did find a spreadsheet and that one had the indicator as N1.

So both, the payment indicator of N1 (Packaged service/item;no separate payment made) and the N status indicator (Items and Services Packaged in APC Rates) shows that this procedure code is bundled into the payment of the primary procedure.

I hoped this helped you in your decision. If you have anymore questions please do not hesitate to connect with me. Have a great day.

 

[Lynda Wetter]

So both, the payment indicator of N1 (Packaged service/item;no separate payment made) and the N status indicator (Items and Services Packaged in APC Rates) shows that this procedure code is bundled into the payment of the primary procedure.

I hoped this helped you in your decision. If you have anymore questions please do not hesitate to connect with me. Have a great day.

Holly, If there is a payment indicator of J1 for an ASC POS 24 procedure can we bill for the device seperately? If so how would we do that? Is it by adding the HCPCS code for the device, for example a drug eluding stent for 92928?

 

[thomas7331]

So both, the payment indicator of N1 (Packaged service/item;no separate payment made) and the N status indicator (Items and Services Packaged in APC Rates) shows that this procedure code is bundled into the payment of the primary procedure.

I hoped this helped you in your decision. If you have anymore questions please do not hesitate to connect with me. Have a great day.

Just to clarify here, 'packaged' does not mean 'bundled' and the N1 indicator does not mean you don't bill for or report that item, it just means that the payment is included the case rate.

I work in outpatient hospital/OPPS, and don't know about rules specific to ASCs in this regard, but packaged items are not bundled - they are to be reported, but there is no separate line-item payment for those items since they are included in the APC rate that is calculated. This is different from bundling, which is a coding term that means an item or service is considered included as a component of another code that is reported on the same claim and same date of service. Packaged items are reported. Bundled items are not reported, unless documentation supports the use a modifier that would allow it.