CODING ■


Research billing/coding/claims fil- ing per payer well in advance of the first procedure.


■


Ensure the scheduler and precer- tification/verification team can “talk the talk.” Schedulers need to know procedure


time allotment,


implants needed, room availability, staffing and a sprinkle of medical necessity and coding. The precer- tification team needs to be knowl- edgeable to pre-certify the proce- dure as well as the implants with the payer(s) to include diagnoses and proposed procedure(s).


■


Determine any additional edu- cational needs for the coder and biller. Your coder might not know the directives and guidelines for every


procedure ■


soon to be performed in an ASC. Don’t put them in a position to fail. Give them the tools and resources needed to ensure these cases are reimbursed accurately and timely before you bring cases to your facility.


Review new procedure operative documentation. Ask the surgeon for examples of operative report dicta- tion from previous similar surger- ies. The coder should review the dictation to determine any poten- tial deficiencies in description that might need to be addressed prior to the procedure being performed. While many orthopedic surgeons


performed or


in ASCs are increasingly performing TKAs safely and effectively on non- Medicare patients and on a select num-


ber of appropriate Medicare patients, some ASCs might not feel equipped to safely perform these procedures. Keep in mind that the inclusion of TKA to the Medicare ASC-payable list does not equate to a mandatory shift in TKA to the ASC setting if the most appropriate care setting might be the inpatient hospital setting for certain Medicare patients; however, proactive analysis of this procedure prior to per- formance when indicated will solidify your facility’s financial health.


Cristina Bentin is the president of Coding Compliance Management LLC in Franklin, North Carolina. Write her at cristina@ ccmpro.com.


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