REGULATORY REVIEW
not on the ASC-approved list. When a physician performs a simple mastec- tomy—a procedure Medicare pays for in the ASC setting—and finds nodes that are positive, the physician ends up performing a radical mastectomy but is not reimbursed for that procedure. This discourages physicians from tak- ing patients who might need a radical mastectomy to the ASC setting. Using current ASC rates, which are approx- imately 55 percent of HOPD rates, Medicare would save more than $4 million on CPT code 19307 alone if only half of the procedures done in the HOPD moved to the ASC setting. For years, ASCA also has requested the addition of several spine codes to the ASC list of approved procedures, including: 22551, 22554, 22612, 63030, 63042, 63047, 63056, and 22614. Commercial insurers already
recognize the value proposition of ASCs and pay for these and other types of procedures outside of the Medi- care ASC procedure list. Our mem- bers report
that they regularly per-
form these procedures on patients in the near-elderly commercially-insured population with excellent results.
Unlisted Codes Commercial payers also commonly give ASCs the flexibility that they need to use unlisted CPT codes to report procedures, which is a practice CMS permits for HOPDs but not for ASCs. A change in this policy could save the Medicare system money and allow ASCs to perform procedures as long as they can provide adequate documenta- tion that the procedure is performed routinely and safely in the ASC setting.
New Procedures in 2014
Although CMS proposed to add zero procedures to the ASC-payable list, it added four new codes in the final rule: ■
27415 (Osteochondral knee allograft) ■ 27524 (Treat kneecap fracture); ■ 60240 (Removal of thyroid); and ■
60500 (Explore parathyroid glands) Of these, 27524, 60240 and 60500 are high-volume codes that ASCA highlighted in its comment letter. ASCA staff will continue to meet with CMS payment policy staff to educate them on which procedures are being done safely, with excellent outcomes, in the ASC setting, and continue to advocate for transparency in the proce- dure list review process.
Kara Newbury is ASCA’s assistant director of government affairs for health policy. Write her at
knewbury@ascassociation.org.
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30 ASC FOCUS JUNE/JULY 2014
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