CODING


CMS Gives the Green Light to Exparel Special coding considerations apply BY CRISTINA BENTIN


With prescription opioid addiction surpassing epi- demic proportions, any effective non-opioid pain management tool that


might prevent further opioid misuse is certainly one to be embraced. According to a 2017 study by the National Safety Council, in the US, the odds of death by an opioid overdose (1:96) is more likely than death by a motor vehicle accident (1:103). In the past, some of the best non-opioid options have proven costly and out of reach for many providers and further exacerbated the continued use of prescription opioids for post- operative pain management. On March 29,


2017, President


Donald J. Trump signed an execu- tive order establishing the Presi- dent’s Commission on Combating Drug Addiction and the Opioid Cri- sis. This commission recommended that the Centers for Medicare & Med- icaid Services (CMS) review its reim- bursement policies specific to bundled payments that make alternative treat- ment options cost-prohibitive for pro- viders, particularly those options for treating immediate postsurgical pain. Under current policies, CMS provides a bundled payment to hospitals that includes hospital-administered drugs to manage postsurgical pain. Medicare Claims Processing Manual Chapter 14 —Ambulatory Surgical Centers states that ASC services, for which payment is included in the ASC payment for a covered surgical procedure, include drugs and biologicals for which sepa- rate payment is not allowed under the hospital Outpatient Prospective Pay- ment System (OPPS).


24 ASC FOCUS MAY 2019 | ascfocus.org


With the CMS reimbursement approval of Exparel in 2019 as a non-opioid pain management alternative, ASCs now have an additional weapon in their arsenal for preventing unintentional opioid misuse that might arise after the performance of common surgical procedures.”


—Cristina Bentin, Coding Compliance Management LLC


Bottomline: rate-setting policies, such as the packaging of drugs and supplies, have unintentionally steered the promulgation of more prescrip- tions for opioid drugs than the use of effective non-opioid drugs since qual- ifying drugs were packaged into the


reimbursement of the surgical proce- dures in which they were used. In keeping with the overall goal of combating the opioid crisis, for 2019, CMS approved separate payment for non-opioid pain management drugs that function as a supply when used in


The advice and opinions expressed in this column are those of the author and do not represent official Ambulatory Surgery Center Association policy or opinion.


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