Issue link: https://beckershealthcare.uberflip.com/i/190596
36 Coding, Billing & Collections Coding & Reimbursement for Spinal Surgery in Surgery Centers: Q&A With Carolyn Neumann By Laura Miller C arolyn Neumann, CPC, Senior Manager, Coding & Coverage Access at Specialty Healthcare Advisers, discusses the challenges for coding spine surgery in ambulatory surgery centers and reimbursement trends for the future. Q: Why is there so much confusion around spine coding and reimbursement? Carolyn Neumann: Spine surgery CPT coding has undergone numerous changes and clarifications in recent years regarding how and when to report procedures. Bundling of procedures into the primary CPT code has affected not only the coding, but reimbursements by Medicare and private payers. Following AMA/CPT guidelines, particularly in spine surgeries, has become a science in itself overshadowing even confusing coverage policies and looming ICD-10 changes. CPT code changes to spine procedure involving revisions, clarification of when a decompression is performed openly or percutaneously, and coding language that just doesn't match up with clinical realities have muddied the waters. Coding these surgeries correctly and avoiding denials has become a moving target. Q: What are the biggest challenges for coding and billing for spine procedures in ASCs? CN: Spine surgeries, beyond interventional procedures, are relatively new to the ASC setting of care. Medicare allows only a few procedures, simple decompressions and fusions, in the outpatient or ASC setting. Private payers are learning quickly the value and efficacy of spine procedures performed by experienced spine surgeons in the outpatient facility and are navigating differing state regulations, credentialing and contracting hurdles to bring spine surgeries onboard at the ASC. Coding standards that are primarily designed for Medicare complicate the coding pathways that must be adopted into outpatient/private payer contracts. Differing payment methodologies (DRG vs. APC or CPT) for