AS I SEE IT
claim referred to as a CMS 1500 claim form. On the other hand, if a procedure were performed in the ASC, or place of service 24, two claims would need to be coded and submitted, with the profes- sional claim on a CMS 1500 form and the facility claim on either a CMS 1450 form (UB 04) or a CMS 1500 form, depending on the payer’s requirements. Further, device insertion or replace- ment codes such as pacemakers, implantable cardioverter-defibrillators (ICD), and event recorders have an ASC payment indicator of J8, which means that the procedure is consid- ered device-intensive. Therefore, for an ASC, Medicare’s payment for the generator/supply is built in to the reimbursement of the procedure code billed by the facility. When used in an OBL, however, the same devices can be reimbursed separately by Medicare. A few examples of add-on codes and other ancillary services that are often provided in conjunction with the primary procedure codes, which are not reimbursable by Medicare to an ASC since they are bundled in with the primary procedure but are reim- bursable in a professional, or OBL setting, include: 1. CPT 33225—Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defi- brillator or pacemaker pulse gen- erator (e.g., for upgrade to dual chamber system).
2. CPT 93641—Electrophysiolog- ic evaluation of single or dual chamber pacing cardioverter- defibrillator leads, including de- fibrillation threshold evaluation (induction of arrhythmia, evalu- ation of sensing and pacing for arrhythmia termination) at time of initial implantation or replace- ment; with testing of single or dual chamber pacing cardiovert- er-defibrillator pulse generator.
3. 36907-36909—Central segment dialysis circuit interventions.
4. CPT 7xxxx series—Codes for im- aging and guidance.
In addition, it is critical that the coders stay informed about the car- diology and vascular procedures that are getting approved by Medicare to be performed in an outpatient set- ting, as the list is increasing rapidly. It is equally important to regularly track the changes in reimbursement. As an example, as mentioned above, one of the drivers for OBLs to move to a hybrid model was the drastic reimbursement reduction that OBLs suffered at the beginning of 2017. Specifically, significant changes in reimbursement for dialysis vascular access care were implemented in 2017 by CMS because of a new payment policy requiring services to be bun- dled if they are billed together more than 75 percent of the time. These reimbursement changes impacted the most commonly performed interven- tional services, thus placing enor- mous financial pressure on OBLs. Examples include a 32 percent reduc- tion in the fee for angiogram of access (CPT 36901), a 40 percent reduction in the fee for angiogram with angio- plasty (CPT 36902), a 30 percent
reduction in the fee for thrombectomy (CPT 36904), and a 20 percent reduc- tion in the fee for thrombectomy with angioplasty (CPT 36905). While there are many more exam- ples, these highlight the necessity of having a strong operational team with highly experienced ASC coders, who are regularly tracking newly approved outpatient procedures and aggressively monitoring reimbursement increases and decreases. This is an exciting time for the car- diology and vascular professions, as many of their procedures will be rap- idly transitioning to outpatient set- tings, be it an OBL, a hybrid OBL/ ASC, a multispecialty ASC or even a single-specialty ASC that has suffi- cient volume to thrive. This is a win- win-win situation for patients, provid- ers and payers alike.
Jessica Edmiston is the senior vice president of coding for National Medical Billing Services in St. Louis, Missouri. Write her at
Jessica.Edmiston@nationalASCbilling.com. Wendy Horton is a certified interventional radiology cardiovascular coder for National Medical Billing Services. Write her at
Wendy.Horton@nationalASCbilling.com.
ASC FOCUS APRIL 2018 |
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