decisionhealth Newsletters, Coder Pink Sheets - 2007 Issue 12 (December)
ASCs: Teach your docs to avoid excluded codes in 2008
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Article Overview
This article explains upcoming Medicare ASC payment rule changes affecting orthopedic practices and ambulatory surgery centers, with emphasis on physician coding education, ASC-excluded services, and the risks associated with unlisted procedures. It is aimed at orthopedic coders, billers, physicians, and ASC scheduling staff who need to understand how the policy shift affects professional fees, facility payment, and coding compliance. The article also points readers to CMS resources and an excluded-code list relevant to orthopedics.
Why This Topic Matters
The topic matters because the 2008 payment rule change can affect whether an ASC receives payment and whether physicians receive a higher professional fee for procedures performed in an ASC setting. It also highlights the operational and audit risk of using the wrong code when no specific code applies.
Article Sections
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Payment rule changes for ASC procedures
Overview of the Medicare ASC payment policy change and how it affects procedures performed in ambulatory surgery centers. Discusses the general impact on physicians and ASCs when a service is not on the ASC code list.
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Unlisted codes and coding education
Focuses on the challenges of reporting services when no exact code is available and the importance of physician and staff education. Covers communication, scheduling workflow, and compliance concerns in orthopedic ASC settings.
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Resources
Points readers to CMS materials and related reference content for further review. Includes guidance on where to find the ASC payment rule and supporting addenda.
What You Will Learn
- How the 2008 ASC payment rule change affects orthopedic practices
- Why physician and staff education is important for ASC-related coding
- What general issues arise when a service is not listed for ASC payment
- Which types of CMS resources support review of ASC-excluded services
Who Should Read This
- Orthopedic coders
- Medical billers
- Physicians
- ASC administrators
- ASC scheduling staff
- Practice managers
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