Coding, Classification & Reimbursement

Surgical procedures in the office

  • 1.  Surgical procedures in the office

    Posted 10 days ago
    I need some advice. I am a biller and coder for an ENT physician. In the last 3 weeks, my physician has performed 2 procedures in his office with 90-day global periods, thus, are not reimbursable in an office POS. I've made my physician aware of this and why but he argues that by doing these procedures in the office, he is saving payers thousands of dollars they would've paid out had he done these procedures in the OR.

    How does a non-clinician like myself explain to a physician why there are some procedures that are required to be performed in an outpatient/ASC setting only vs. physician's office?

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    Ryan Stroup
    Biller/Coder, ENT
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  • 2.  RE: Surgical procedures in the office

    Posted 10 days ago

    Hi Ryan,

    I would assume that physicians have the basic knowledge of patient safety in terms of surgical risks.  Saving the patient thousands of dollars would not be worthwhile if it meant putting the life of the patient at risk.  Probably it would mean he is putting his practice at risk as well (like a lawsuit).  Like you said there is a reason why a certain procedure or surgery needs to be done in the OR.  One reason that comes to mind is that the hospital has the correct medical equipment/supplies and clinical manpower should the patient experience a surgical complication that is emergent and life-threatening.

    I'm wondering if the ENT physician is performing procedures that would normally be done in an ASC setting or in the hospital-based outpatient department setting, how he can even get paid appropriately for his services. 

    Perhaps, you can help to educate the ENT physician by using materials from legit sources such as your state's laws.  For example, I found this document regarding office-based surgery on Oregon.gov: https://www.oregon.gov/omb/Topics-of-Interest/Pages/Office-Based-Surgery-Proposed-Rules.aspx.  There is a wealth of free information on the internet (and printed materials) and putting together a coherent material that only contains information from valid sources is one inexpensive thing that can be done.  Just my personal thoughts.



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    Cristina Co
    Facility Outpatient Coder
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  • 3.  RE: Surgical procedures in the office

    Posted 9 days ago
    Christina,

    Thank you so much for your input and the provided information! I was actually thinking along the same lines as you in terms of risks to the patient most importantly but also to his practice if there were complications during a procedure. Good to know I was on the right track.

    Thanks again,

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    Ryan Stroup
    Biller/Coder, ENT
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