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CODING


would be processed. Since some pay- ers don’t allow for the billing of the amount of the drug wasted or have differing billing directives, ASCs will need to contact individual payers to verify “if” and “how” drug wastage can be reported. Assignment. According to the Medicare Claims Processing Manual Chapter 17, payment for drugs cov- ered under Part B of Medicare are by an assignment-related basis. Medi- care patients may not be billed for any amount except for any applicable deductible and coinsurance amounts that have not been satisfied. Payers. With CMS separately reim-


bursing for C9290, Injection, bupiva- caine liposome, 1 mg, many commer- cial payers are following suit. Some Aetna products for example have already


expanded their coverage of Exparel to dental procedures. ASCs should per- form their due diligence by reviewing their contracts and reimbursement trends


for Exparel. They should also determine whether the contract follows CMS reim- bursement methodology, review contract terms for the reporting and reimburse- ment of drugs and biologicals and con- tact any carriers who are not reimbursing for Exparel to provide them with CMS reimbursement policies. 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 uninten- tional opioid misuse that might arise after the performance of common sur- gical procedures.


Cristina Bentin is the president of Coding Compliance Management LLC in Baton Rouge, Louisiana. Write her at cristina@ ccmpro.com.


26 ASC FOCUS MAY 2019 | ascfocus.org


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