CODING
Considering Adding TKA to Your Case Mix? Do your due diligence and a financial analysis first BY CRISTINA BENTIN
While the ASC industry continues to celebrate the addition of total knee arthroplasty (TKA), CPT 27447, Arthroplasty, knee,
condyle and plateau; medial and lat- eral compartments with or without patella resurfacing (total knee arthro- plasty) to the Medicare ASC-payable list beginning January 1, 2020, facili- ties will want to perform a financial due diligence analysis prior to adding these procedures to their case mix. According to Medicare, TKA is a
device-intensive procedure (J8 pay- ment indicator) priced at approximately $8,600 with specific rates adjusted for geographic differences via the local wage index. ASC device-intensive pro- cedures are those procedures with a device offset percentage greater than 30 percent based on the standard OPPS APC rate-setting methodology.
This
designation also means that the total device cost will be included in the reim- bursement rate when the procedure is performed in an ASC. The verdict is still out regarding whether the reimbursement that the Centers for Medicare & Medicaid Ser- vices (CMS) applied to this procedure is too low to encourage migration from the inpatient space for Medicare ben- eficiaries. Nonetheless, an aggressive analysis prior to the introduction of this procedure, as well as all new pro- cedures, is necessary for the financial health of your facility. Don’t overlook the important task of researching reimbursement prior to performing these procedures. Implant reimbursement alone can break your bank. Input from both your clinical and business teams is needed, first, to under-
stand the physician’s preferences in equipment, implants and supplies and, then, in the understanding of the sepa- rate or packaged reimbursement of these preferences pending payer contracts. Insurance payers might offer an
overall reimbursement for the pro- cedure that includes the payment for the implant instead of reimbursing separately for the procedure and the implant. Procedure reimbursement that is inclusive of the implant might look good on paper, but the overall reimbursement might be less than the cost to perform the case in your facil- ity. Do your research:
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Determine all costs to perform this case/procedure in your facility. Discuss equipment needs required to provide quality care without exceeding the budget. Review sur- geons’ preference cards and deter- mine which supplies and equip- ment you will have to purchase and where you can lower costs by switching to comparable quality brands. There is a MacGyver in all of us that sometimes forces us to be more innovative or to “make do.” For example, if the surgeon ordinarily uses a particular type of specialty-specific OR table, it
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. ASC FOCUS FEBRUARY 2020 |
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