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Tell Your Patients to Drink Up - Outpatient Surgery Magazine - March 2019

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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3 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • M A R C H 2 0 1 9 I 'm not saying you must become a reimbursement guru, but in the busi- ness of surgery, where your revenue is gener- ated by how you code your cases, you should at least have a solid grasp of the complex world of CPT coding. Otherwise, you won't capture all of the rev- enue to which you're entitled. A good place to start is avoiding these 3 common reimbursement traps. Not staying current on CPT codes. CPT procedure codes are updated annually. If you don't keep up with the yearly changes, you'll likely leave money on the table. Take, for example, C9290, the product-specific HCPCS code for Exparel (liposomal bupivacaine) that took effect Jan. 1, 2019. CMS temporarily gave Exparel "pass- through" status — separate reimbursement from bundled surgical supplies for at least 2 but not more than 3 years to encourage the use of innovative drugs, devices or biologicals — from 2012 to 2014 in both the hospital outpatient and ASC settings. When CMS withdrew pass-through status for Exparel in both settings, usage, as you might 1 3 Reimbursement Traps to Avoid How to steer clear of these common revenue-killers. Coding & Billing Paul Cadorette, CPC, CPC-P, COC, COSC, CASCC • KEEP CURRENT If you don't keep up with the annual changes to CPT procedure codes, you'll likely leave money on the table — or submit claims on which payers will delay or deny payment.

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