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ASC Key Specialties: Ophthalmology, GI & Orthopedics Coding & Billing Issues to Know

Written by Carrie Pallardy | March 31, 2014

Ophthalmology, gastroenterology and orthopedics are the most common ambulatory surgery center specialties. Ophthalmology accounts for 29 percent of all ASC case volume, gastroenterology 17 percent and orthopedics 17 percent, according to VMG Health's ASC Intellimarker Survey 2011.

Here are a few important coding and billing issues and statistics for leaders of ophthalmology, GI or orthopedics-driven ASC leaders to know.

Several changes have been made to the 2014 Current Procedural Terminology code set. Code 0192T has been deleted and replaced with code 66183, which refers to the insertion of an anterior segment aqueous drainage device without an extraocular reservoir, according to president of Ellis Medical Consulting Stephanie Ellis, RN, CPC, in a recent Becker's ASC Review report.

Cataract surgery with IOL insert 1 stage was the most frequently performed ASC procedure in 2012 at 16.9 percent of total volume, according to MedPAC data. Of total billed amounts from Nov. 15, 2012 to Feb. 11, 2013, 7 percent of total denied claims were for cataract surgery with IOL insert, 1 stage, according to RemitDATA.

Approximately a quarter of the 2014 CPT code changes affect GI codes, according to the American Medical Association. Additions to the 2014 CPT code set cover procedures such as esophagoscopy, esophagogastroduodenoscopy, endoscopic retrograde cholangiopancreatography and image-guided fluid collection drainage by catheter, according to Ms. Ellis.

Upper GI endoscopy with biopsy and colonoscopy with biopsy are two of the five most frequently performed ASC procedures at 8.1 percent and 5.8 percent of total case volume, respectively, according to MedPAC data. From Nov. 15, 2012 to Feb. 11, 2013, colonoscopy and biopsy accounted for 9 percent of all claims denials and upper GI endoscopy with biopsy accounted for 8 percent, according to RemitDATA.  

There are a number of significant CPT code additions to the 2014 Medicare ASC list. "[For example], code 27415 for open osteochondral allograft, knee, open,  is  an existing CPT code, which is newly-added to the Medicare ASC list for 2014 with an average Medicare payment of $2,242," says Ms. Ellis.

An AIS Health report released early this year indicated that orthopedic and spine procedures may be faced with increased scrutiny. One such procedure, joint replacement, has a 12.6 percent Medicare improper payment rate. Medicare contractors are now conducting pre- and post-payment review of joint replacement procedures. They expect proof of exhaustion of conservative treatment prior to surgery.

Spinal fusion has also been placed on the Program for Evaluating Payment Patterns Electronic Report list of risk areas. Coders are tasked with understanding the technologies surgeons use to ensure the codes accurately reflect procedures performed.

CPT Copyright 2013 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

More Articles on Coding and Billing:
Two Financial Tips to Boost Patient Volume
10 Highest Billed Urology Procedure Unexpected Denial Rates
21 Types of Healthcare Staff Who Need ICD-10 Education

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