At the 18th Annual Ambulatory Surgery Center Conference in Chicago on Oct. 29, Stephanie Ellis, RN, CPC, president of Ellis Medical Consulting, gave a presentation titled "How to Improve Coding for ASC Procedures — A Discussion of Orthopedic, GI and Ophthalmology Procedures." Ms. Ellis discussed the ins and outs of coding for several key procedures, including:
• Knee procedures
• Shoulder procedures
• Platelet-rich plasma
• Colonoscopies
• Cataracts
• Ankle surgery
She cautioned ASC administrators to educate physicians and schedulers about which procedures don't reimburse well in the surgery center so they can perform those cases in the hospital. Also check the status of the patients' insurance coverage before scheduling a procedure. The most successful ASCs also pay attention to regulatory issues for billing and coding. Ms. Ellis relayed a story about an ophthalmologist who was targeted for selling lenses directly to his patients at a higher price than the ASC.
"The ophthalmologist was in trouble for marking up the price and the ASC was in trouble because they were allowing him to handle the lens transaction," she said. "Physicians can't have any part in selling the lens to their patients."
In this situation, physicians are still allowed to educate patients in their office, but not sell the lens directly to them.
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• Knee procedures
• Shoulder procedures
• Platelet-rich plasma
• Colonoscopies
• Cataracts
• Ankle surgery
She cautioned ASC administrators to educate physicians and schedulers about which procedures don't reimburse well in the surgery center so they can perform those cases in the hospital. Also check the status of the patients' insurance coverage before scheduling a procedure. The most successful ASCs also pay attention to regulatory issues for billing and coding. Ms. Ellis relayed a story about an ophthalmologist who was targeted for selling lenses directly to his patients at a higher price than the ASC.
"The ophthalmologist was in trouble for marking up the price and the ASC was in trouble because they were allowing him to handle the lens transaction," she said. "Physicians can't have any part in selling the lens to their patients."
In this situation, physicians are still allowed to educate patients in their office, but not sell the lens directly to them.
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