Wiki Spine Cases Implants ASC

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pinnaclephyserv

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Can anyone help me with understanding how to get implants paid w/Medicare? Only one code is payable 63047 and all others are on the Inpatient Only List. The implants cost $8,000, so we can't continue those kind of cases...

HELP!
 
There's no way to (legally) bypass Medicare's payment rules. But implants and surgeries are two different things. Implants are usually packaged into the case rate for the surgical procedure and don't get a separate payment - the payment for the surgery itself is calculated to cover the cost of any implants involved. As for codes that are on the inpatient-only list, you will not get paid for these - these codes are never reimbursed to a facility on an outpatient claim. They are only paid as a component of the DRG rate for an inpatient hospital claim. Your physician should not be scheduling these types of procedures to be done at an ASC for Medicare patients.
 
I agree with Thomas. Your scheduler/insurance verifier should alert the business office manager when these types of cases are scheduled so they can have a conversation with the clinical team and/or surgeon. You are looking at a major loss that can be avoided by looking at the payable codes vs implant cost prior to surgery. :(
 
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