Medicare Compliance & Reimbursement

Find out what the two-year review of the ASC list means for hospitals. The Centers for Medicare & Medicaid Services tipped its hand on which codes will be slashed from the ambulatory surgical center list of covered procedures.

CMS plans to add 25 new Medicare-approved codes, but it also plans to scrap 100 established codes, according to a proposed rule in the Nov. 26 Federal Register. The agency said procedures were slated for deletion because they were performed in a physician's office more than 50 percent of the time, labeled as a "safety concern" by medical specialty organizations, performed predominantly in the inpatient setting or marked for deletion by the HHS Office of Inspector General.

However, CMS wants to keep three of the 11 CPT codes the OIG has proposed to delete from coverage. CMS still plans to cover cautery and laryngoscopy codes 30802, 31525 and 31570, because physicians perform the procedures less than 50 percent of the time in the office, according to 2002 claims data.
 
"While the remaining eight procedures may be safely performed in a physician's office for the majority of patients, our medical advisors believe that, in certain cases, the patient's health or medical condition may demand the more extensive services afforded by ASCs in order to ensure a safe surgical outcome," CMS said.

Lesson Learned: An updated ASC list shows that CMS may not be prepared to make sweeping coverage improvements.