Additions to the ASC list finally out — centers have reason to celebrate
Almost 300 additions are welcomed, but about 145 deletions posted
The list of approved procedures for the ambulatory surgery center (ASC) is free at last! Leaders in the field have been calling for the updated list of ASC-approved procedures, which was last changed in 1995. Officials at the Centers for Medicare & Medicaid Services (CMS) finally responded.
As of July 1, 2003, ASCs can be reimbursed for almost 300 procedures that were proposed as additions to the list in 1998. For explanation of why the update was delayed click here.)
"The additions will allow us to bring many new procedures to our center," says Jerry Henderson, RN, CNOR, CASC, executive director of Surgi-Center of Baltimore in Owings Mills, MD. "Now ASCs can offer Medicare beneficiaries many of the same high-quality, cost-effective procedures that we provide our other patients."
Managers at Minnesota Eye Laser & Surgery Center in Bloomington are very pleased by the additions, especially relating to oculoplastics and astigmatism surgery, says Peggy Halvorson, RN, CNOR, nurse manager.
"We have been referring many of our Medicare oculoplastics patients to a hospital setting, which obviously has been costing CMS and the patient more money than doing them in an ambulatory setting," Halvorson says.
Janice Roach, executive director of Tri-City Regional Surgery Center in Richland, WA, says, "We are pleased with the additions, especially adding endoscopic carpal tunnel, arthroscopic rotator cuff repair, more variations to hernia procedures, and blepharoplasty."
"Delighted" and "very pleased" also were the reactions of leaders of same-day surgery associations after the March 28, 2003, final notice in the Federal Register. (For more information on how to access the notice, see the "Resources" section at the end of this article.)
"AAASC successfully persuaded CMS to reverse many of the undesirable changes it proposed in 1998," says Craig Jeffries, executive director of the American Association of Ambulatory Surgery Centers (AAASC) in Johnson City, TN. For example, AAASC representatives persuaded CMS to retain three urodynamics procedures: 51726 (complex cystometrogram), 51741 (electro-uroflowmetry), and 51785 (anal/urinary muscle study) and four nerve block procedures: 64420, 64421, 64622, and 64623 (injection of nerve block), he says.
Most of the added codes were proposed in 1998, according to Kathy Bryant, executive director of the Federated Ambulatory Surgery Association (FASA) in Alexandria, VA. (See list of additions.)
The assignment of some of the procedures to group nine will allow Surgi-Center of Baltimore to perform procedures that it previously did not because of poor reimbursement from other payers, Henderson says. "We will now have to go back to the other payers to see how they will handle the ninth group," she says.
Overall, the additions will have mixed impact on ASCs depending on the types of contracts the ASC has with their other carriers regarding ungrouped procedures, Henderson says. Some of the procedures on the addition list would be paid at a percentage of charges by some payers with the old list, she says.
"Now that they are on the ASC list, they will be paid at the Medicare grouper category to which it is assigned," Henderson says. "This may or may not be better for the center."
Unfortunately, about 100 procedures proposed to be added in 1998 were not added, Bryant said in a Medicare Alert sent to FASA members. "Most of these were ones that were proposed at low reimbursement levels, but a few were not added after other groups objected to their addition," she wrote. These objections point to the need for physicians at surgery centers to be active in their national medical associations, Bryant says.
Roach says, "We are disappointed that they did not add laparoscopic cholecystectomy or lithotripsy."
It is unfortunate that CMS did not add numerous ophthalmic laser procedures that are important to ophthalmologists and appropriate for the ASC, says Eric Zimmerman, JD, partner with McDermott, Will, and Emery in Washington, DC. Also, "it is bad news in that CMS still has not dealt with the many codes that commenters suggested be added, or other important changes, like updating the criteria used to determine whether procedures should be on the ASC list," he says.
Managers at ASCs that specialize in dermatology, gastroenterology, and orthopedics may object to the fact that certain procedures that were proposed in 1998 were not added, CMS acknowledged in the final rule.
"In particular, we are not adding procedures performed more than 50% of the time in a physician’s office, procedures that are not appropriately or safely performed in an ambulatory setting, or procedures that would otherwise have met the criteria for inclusion on the ASC list except that they would be significantly overpaid in the lowest ASC payment group," the notice said. "We have determined that the adverse economic impact on the Medicare program that could result from a shift of such services to an ASC setting outweighs the potential negative reaction of these medical specialties."
CMS proposed to delete 203 procedures from the ASC list in 1998; however, CMS changed its position on several procedures and will delete only about 145 codes. ASCs can continue to provide these deleted services and bill for them until July 1, 2003. (See list of deleted codes.)
Officials with the American Hospital Association (AHA) are reviewing the changes to see if rates have increased beyond the inflationary update, according to Amy Lee, spokeswoman for the Washington, DC, office of the AHA. "Our concern is where ASC payment rates are higher than hospitals for the same procedure," she says.
Recently, the Office of Inspector General (OIG) for the Department of Health and Human Services recommended uniform payments rates for outpatient services provided in ASCs and hospital outpatient departments. In addition, the Medicare Payment Advisory Commission (MedPAC) has recommended to Congress that no surgical procedure be paid more in an ASC than a hospital outpatient department.
AAASC and FASA are working with their members to submit comments on other procedures that are ready for the ASC setting but were not included in the final rule, Jeffries and Bryant say.
FASA officials are eager to discuss with CMS the decision not to add certain codes, such as 29873 (knee arthroscopy with lateral release), Bryant says. "We recognize that as long as there is a list, it will always be a little behind what is happening with private payers," she says.
All codes that can be safely performed in an ASC should be added, Bryant maintains. "To deny Medicare beneficiaries access while others can have it makes no sense, especially in light of how long it takes CMS to update the ASC list," she says.
Bryant points to laparoscopic cholecystectomy as one example of a procedure that should be added to the ASC list. CMS concedes that it is appropriate in the ASC for some Medicare beneficiaries, but others need an overnight stay, she says.
"To deny all access because some may need a hospital stay is unfair to those that don’t," Bryant maintains. "Moreover, if the list isn’t updated for another eight years, this decision could impact the majority of Medicare beneficiaries."
Resources
The Federal Register document is available free from the on-line database through GPO Access. The web address is www.access.gpo.gov/nara/index.html. Also, you can view and copy the Federal Register at many libraries. To order copies of the Federal Register, send your request to: New Orders, Superintendent of Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954. Specify the date of the issue requested (March 28, 2003) and enclose a check or money order payable to the Superintendent of Documents, or enclose your Visa or Master Card number and expiration date. Credit card orders also can be placed by calling the order desk at (202) 512-1800 or by faxing to (202) 512-2250. The cost for each copy is $10.
For further information on information in the Federal Register notice, contact: Bob Cereghino, Centers for Medicare & Medicaid Services. Telephone: (410) 786-4675.
The deadline for comments on the Federal Register notice is May 27, 2003. Mail written comments (one original and two copies) to the following address: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1885-FC, P.O. Box 8013, Baltimore, MD 21244-8013. Please refer to file code CMS-1885-FC.
The list of approved procedures for the ambulatory surgery center (ASC) is free at last! Leaders in the field have been calling for the updated list of ASC-approved procedures, which was last changed in 1995. Officials at the Centers for Medicare & Medicaid Services (CMS) finally responded.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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