Becker's ASC Review

16 12th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference + The Business of Spine - call (800) 417-2035 For the ASC coder this new regulation will create an additional and possibly unnecessary administrative burden demanding research to determine which new codes are considered add-ons and should therefore be omitted for the facility on the one hand, while requiring documenting and reporting for the physician on the other. Furthermore, the coder will have to be aware of the patient's coverage because the ASC may continue to receive payment from the commercial carriers. This will significantly impact the methodology for how coders approach every procedure because they may not possess access to the specific rules and contract details when attempting to apply the proper code(s). The logistics of payment posting in correlation with reporting the N1 codes has also become a challenge for some ASCs and billing organizations. Some have experienced inaccuracies with automatic posting ("auto posting") when the codes are reported due to how the ASC's billing software system is set up to receive ANSI codes. Systems need to be reviewed to ensure N1 code balances are adjusted appropriately at the time of auto posting to prevent manually adjusting each code. There are also some instances where reimbursement for specific procedures and specialties can be negatively affected with the N1 status updates. For ex- ample, the implantation of mesh for hernia procedures (CPT 49568) will no longer be reimbursed. This is a loss of approximately $681.50 per procedure for the ASC. The subacromial decompression of the shoulder (CPT 29826) is another procedure that will no longer receive payment from Medicare and that equates to a $592.00 total deficit per procedure. In an attempt to offset the financial loss from non-payment of the add-on procedures, Medicare has increased reimbursement for some initial procedures, such as CPT 64493 for the initial level pain injection. Unfortunately, this has not occurred consis- tently across the board thereby resulting in a number of ASCs standing to incur loss of revenue. The recommendation by Medicare to omit line items for packaged services has created some confusion for ASC coders and thus is producing consider- able conjecture and varying viewpoints on those new guidelines. Many cod- ers opine there are inconsistencies in what should and should not be reported and without a governmental standardized policy throughout the industry, which application should be heeded? Coders heretofore have been tradition- ally instructed to report that which is documented, but going forward with this new regulation could impel that philosophy to change. n 12th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference + The Future of Spine June 12-14, 2014 • Chicago To learn more or register, visit www.beckersasc.com/beckers or call (800) 417-2035 132 Sessions • 168 Speakers • 63 Physician Leaders • 28 CEOs Keynote Debate: Former U.N. Ambassador & Republican Diplomat John Bolton Former Six-Term Democratic Governor of Vermont Howard Dean

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