Outpatient Surgery Magazine - Subscribers

No More Empty Beds - Outpatient Surgery Magazine - February 2020

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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• AMA bundling guidance. The American Medical Association's guidance is less structured than the NCCI edits, meaning it's more likely for providers to report CPT codes separately to increase reim- bursement. If you don't pay close attention to which method your payers use, you could be coding incorrectly or leaving a significant amount of reimbursement money on the table. Let's look at how these bundling methods differ as well as the best practices your coders and billers should use to get the most out of each. Payer contracts Accurate, efficient and profitable bundling is based on the payer con- tract. Review your contracts with a fine-tooth comb, and make sure coders and billers are acutely aware of which edits your payers fol- low. Many facilities simply follow NCCI edits for all payers, regardless of what an individual payer's policies state, as a precautionary policy or form of under-coding. After all, if you're following strict, widely accepted NCCI guidelines to the letter, there's little risk of up- or over- coding. While there's nothing wrong with being safe, you could be leaving a lot of money on the table if you follow this one-size-fits-all approach to bundled payments. For example, consider an arthroscopic rotator cuff repair (CPT 29827) performed with and an arthroscopic limited debridement of superior labral tearing (CPT 29822). If the payer is using the NCCI edits, the debridement of superior labral tearing (CPT 29822) would be considered bundled if it was performed on the ipsilateral or same shoulder as the rotator cuff repair. However, if the payer is following AMA bundling guidelines, CPT 29827 and CPT 29822 can be reported separately. In other words, you'll get reimbursed at a higher rate if you go by the AMA guidelines. F E B R U A R Y 2 0 2 0 • O U T PA T I E N T S U R G E R Y. N E T • 2 5

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