Q Our facility uses a lot of implants for surgical fixation and small-joint reconstruction. These devices increase our overhead for some procedures. Can we obtain reimbursement to offset the implant costs in addition to the cost of the surgical procedure?

A Yes, you can bill for high-cost items, such as joint implants, plates, screws and arrows, that fall outside the global surgical package. Medicare requires that you use HCPCS codes for prosthetic devices; however, the approved list for ASC implant reimbursement is minimal (see "Sample Approved Prosthetic Device Codes" below). For Medicare claims, bill the device in conjunction with a Medicare-approved ASC procedure code.

On UB-92 claims, use HCPCS codes whenever applicable. If no HCPCS is available, use 99070 (miscellaneous surgical supplies). Assign revenue code 278 in box 42 of the claim form. As with all implant reimbursement requests, be sure the physician's operative report clearly identifies and documents the implanted joints and their medical necessity for the procedure.

Your reimbursement depends on the carrier's coverage terms and contract language. Most carriers do not offer implant reimbursements unless you specifically negotiate an implant carve-out. Some contracts may include all supplies regardless of the cost in the reimbursement rate for the surgical procedure. When billing for implants, be sure you have an invoice listing type of supply, supplier and cost. Many carriers are willing to reimburse the cost with an allowance for shipping and handling.

Q Is it possible for our ASC to be reimbursed for implantable vascular access portals, catheters and reservoirs?

A Yes, ASCs can get reimbursed for vascular portals (HCPCS A4300 and A4301) when used with CPT codes 36489 and 36533. Under most reimbursement contracts, you must include an invoice when billing for these implantable devices, as well as documentation specifying their medical necessity.

Q Will insurance carriers reimburse our facility based on coding, billing and reimbursement guidelines we obtain from our implant device suppliers?

A You certainly may use information obtained from a supplier or manufacturer as guidance for billing your carriers for their implantable items, but don't take the supplier's information as gospel. Suppliers may not always have the latest carrier-specific implant coding, billing and reimbursement information. It is important that you also research your carriers' implant billing and reimbursement guidelines. This is the only way to ensure accuracy and avoid possible false-claim charges for billing improperly. Always check with your carriers for proper coding and billing guidelines before submitting a charge for any new service.

Q Our board of directors asked us to track implant reimbursement by payer, but our software system cannot provide this information. Is there a simple way to track this information and put it into an easily understood report?

A Spreadsheets are an effective means of tracking this type of information. The sample spreadsheet in "Implant Reimbursement by Payer" above is an example of a convenient and easy-to-understand way to calculate and track reimbursements by payer, provider or supply. You can also formulate the percentage of reimbursement against total charges and total cost. This report can be used in your contract renegotiations, and for inventory control and cost management.