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.
