Thursday, April 14, 2016

ASC Billing and Code Changes for 2015

At the end of October, CMS released its final 2015 ASC payment rule and in November the 2015 CPT® Manuals were released containing the new, deleted and revised CPT® and Category I and II billing codes.

ASCs were given a 1.4 percent increase (up from 1.2 percent increase in the proposed rule) in Medicare payments, based on a 1.9 percent adjustment to the consumer price index, minus a 0.5 percent productivity adjustment. However, CMS continued to use the Consumer Price Index for All Urban Consumers (CPI-U) to update ASC rates instead of using the Hospital Market Basket cost measures, which in 2015 will increase hospital payments by 2.2 percent.

The ruling finalized 10 spine procedures added to the ASC list of payable services and added an additional CPT® code (63044) to the list. CMS recognized that CPT codes 22551, 22554, and 22612 were assigned to the wrong ambulatory payment classification (APC 0208). The final rule moved these codes to APC 0425, which has a higher reimbursement. An esophageal reflux test was also added as payable in the ASC setting in 2015. The new codes are:

** 22551 – Neck Spine fuse & remove bel c2
** 22554 – Neck spine fusion
** 22612 – Lumbar spine fusion
** 22614 – Spine fusion extra segment
** 63020 – Neck spine disk surgery
** 63030 – Low back disk surgery
** 63042 – Laminotomy, single lumbar
** 63044 – Laminotomy, additional lumbar
** 63045 – Removal of spinal lamina – cervical
** 63047 – Removal of spinal lamina – lumbar
** 63056 – Depress spinal cord
** 91035 –Esophagus, gastroesophageal reflux test with mucosal attached telemetry pH electrode placement, recording, analysis and interpretation

There have been many other changes in the CPT and Category I and II codes for 2015 that affect ASCs.

There are:

** 44 New CPT® codes for 2015
** 24 New Category I and Category II Codes
** 50 Deleted/Discontinues CPT codes
** 29 Deleted/Discontinued Category I and II Codes

The Ambulatory Surgery Center Association (ASCA) has added resources to their website listing all the code changes with an objective to assist ASC operators in determining the impact of the 2015 Medicare changes. The information is available to ASCA members and to non-ASCA guest members, who must obtain a password to view the information.

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