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News -> August, 2003 News
The patient advocacy committee continues to work to enhance our ability to provide state-of-the-art care to our patients. The most recent issue has been the exclusion of 61795 from the list of CMS approved procedures performed in an ambulatory surgical center (ASC). Since this was exclusively a neurosurgical code prior to January 2000, it did not appear on the list. The implications of this are that the ASC would not be reimbursed for a facility fee for 61795. This omission does not affect the professional fee. However, as most of us have learned, large capital purchases by surgery centers are generally not considered unless there is a measurable cost benefit to the facility. The ARS through its legal counsel has petitioned CMS to include 61795 on the list of approved procedures for an ASC. The basic argument was that since this is an add-on code, and the CPT codes to which it is typically linked were on the list, 61795 should be included. The formal letter that was submitted to CMS May 27, 2003, is posted here.
The practice expense (PE) component of all but the 90-day global period codes have been submitted to CMS. Their proposed rule should be available in June 2003. The final rule will be published in November or December 2003. The PE component of the 90 day global CPT codes will be presented to the Practice Expense Advisory Committee (PEAC) in January of 2004. Since reimbursement dollars are fixed, the final rule including all CPT codes may result in some adjustment of the values of CPT codes presented in this year's final rule.
Finally, Don Lanza and Fred Kuhn represented the ARS at a recent meeting with CMS regarding 31237. CMS has considered several options to reduce what they believe to be "over utilization". Data was presented to suggest otherwise, and CMS has agreed to investigate and continue communication with the ARS and our Academy.
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