Outpatient Surgery Magazine - Subscribers

Clear Cut - July 2015 - Outpatient Surgery Magazine

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 1 J U LY 2 0 1 5 | O U T P A T I E N TS U R G E R Y. N E T in the proposed rule and moved these codes to APC 0425, which has a higher reimbursement than the group to which they were originally assigned. But because spine cases often have multiple codes associated with one case, the new additions have made billing for these proce- dures tricky. The 2015 rule left many wondering how to submit claims to Medicare for their spine cases since only some of the procedures commonly performed together have made the list. Billing for complicated spinal cases The inclusion of some, but not all, of the spinal codes is problematic. Take, for example, a spine surgeon who performs a medically neces- sary anterior cervical discectomy and fusion surgery (CPT 22551 and 22552), with morselized allograft (CPT 20930), application of interver- tebral biomechanical device (CPT 22851) and anterior instrumenta- tion of 2 to 3 vertebral segments (CPT 22845) in an ASC. We know that 22552, 20930 and 22851 are routine components of the main code, 22551, and that most surgeons often use the anterior plate with or without the cage when performing the core procedure. Cases z TRICKY BILLING CMS's addition of some spinal codes without other commonly-related ones creates billing confusion for ASCs.

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