Issue link: https://beckershealthcare.uberflip.com/i/1416329
24 CODING & BILLING 9 procedures CMS plans to keep on the office-based payable list By Patsy Newitt T he proposed 2022 Hospital Outpatient Prospective Payment System and ASC Payment System, released July 19, outlined nine procedures slated to temporarily remain on CMS' office- based payable list in 2022. The procedures, which include ophthalmology and cardiology surgeries, were temporarily approved as office-based procedures in 2021. CMS also proposed two new procedures to be temporarily placed on the office-based payable list. CMS accepted comments on the 2022 proposed rule through Sept. 17. Here are the nine procedure codes proposed to remain on CMS' office-based payable list: Code Long Descriptor 64454 Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging guidance, when performed 65785 Implantation of intrastromal corneal ring seg- ments 67229 Treatment of extensive or progressive retinopathy, 1 or more sessions, preterm infant (less than 37 weeks gestation at birth), performed from birth up to 1 year of age (eg, retinopathy of prematurity), photocoagulation or cryotherapy 0402T Collagen cross-linking of cornea, includ- ing removal of the corneal epithelium and intraoperative pachymetry, when performed (report medication separately) 0512T Extracorporeal shock wave for integumentary wound healing, high energy, including topical application and dressing care; initial wound 0551T Transperineal periurethral balloon continence device; adjustment of balloon(s) fluid volume 0588T Revision or removal of integrated single device neurostimulation system including electrode array and receiver or pulse genera- tor, including analysis, programming, and imaging guidance when performed, posterior tibial nerve 93985 Duplex scan of arterial inflow and venous out- flow for preoperative vessel assessment prior to creation of hemodialysis access; complete bilateral study 93986 Duplex scan of arterial inflow and venous out- flow for preoperative vessel assessment prior to creation of hemodialysis access; complete unilateral study Here are the two ASC procedures newly designated as temporarily office-based: Code Long Descriptor 42XXX Drug-induced sleep endoscopy, with dynam- ic evaluation of velum, pharynx, tongue base, and larynx for evaluation of sleep-disordered breathing, flexible, diagnostic 53XX4 Periurethral transperineal adjustable balloon continence device; percutaneous adjustment of balloon(s) fluid volume n UPMC surgeon performed, billed for illegal overlapping surgeries, lawsuit alleges By Alan Condon T he Justice Department is suing UPMC, its chair of cardiothoracic surgery and University of Pitts- burgh Physicians in a whistleblower suit brought by a former UPMC physician. Over the last six years, prosecutors allege that the de- fendants illegally submitted hundreds of false claims to Medicare, Medicaid and other government health programs. James Luketich, MD, UPMC's longtime cardiothoracic chair, allegedly performs up to three complex surger- ies at the same time, does not participate in "key and critical" portions of his cases and has patients under anesthesia for long periods as he moves between operating rooms, the Justice Department alleged in a Sept. 2 news release. Federal law prohibits surgeons at teaching hospitals from billing CMS for two concurrent, or overlapping surgeries unless the surgeon is present for all "critical or key portions" of the procedure. Prosecutors also said that breaking this law violates the standard of care, patients' trust and increases the risk of serious complications. "Doctors take an oath to uphold the highest levels of ethical standards and care," said FBI Pittsburgh Special Agent in Charge Mike Nordwall. "The allegations set forth today violate those ethics, painting a picture of fraud and deception." n