We all know and love total joint procedures in ambulatory surgery centers (ASCs). The Centers for Medicare & Medicaid Services (CMS) continues to expand procedures that make the Medicare approval list that most payers honor (i.e., if the procedure is not on that list, the procedure cannot be performed in an ASC). Many may not understand that, but that is for another column.

If you are not at least talking to your local cardiologist about a cardiac lab in your ASC, you are missing a golden opportunity. Two of the most desirable procedures for ASCs in 2020 and beyond are cardiology and vascular procedures, which CMS has just blessed for ASC reimbursement. This includes most catheterizations, angioplasties, and stenting procedures. Setting up a cardiac lab in an ASC requires some homework. They are not necessarily difficult or terribly expensive, but there are fine details worth understanding well. Rewards include the following current procedural terminology (CPT) codes and reimbursement, although this may vary by ZIP code:

  • 37227: Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed = $10,940.75;
  • 37226: Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed = $6,444.32;
  • 37238: Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; initial vein = $6,193.74;
  • 36906: Transcatheter placement of intravascular stent(s), peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis circuit = $10,181.47;
  • 33207: Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); ventricular = $7,633.32;
  • 33249: Insertion or replacement of permanent pacing cardioverter-defibrillator system = $26,699.15;
  • 92928: Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty, when performed; single major coronary artery or branch = $6,057.39.

Be careful, as the devices can be outrageously expensive. Conduct thorough research to find the most sensible deals. While some procedures have been on the CMS-approved list for a while, most people do not know about them. This reinforces the need to always stay on top of what CMS is up to. Over the coming years, CMS could push more cases and procedures to ASCs. Thus, many hospital outpatient departments may convert to ASCs. Keep following those developments closely.

(Earnhart & Associates is a consulting firm specializing in all aspects of outpatient surgery development and management. Address: 5114 Balcones Woods Drive, Suite 307-203, Austin, TX 78759. Phone: (512) 297-7575. Fax: (512) 233-2979. Email: searnhart@earnhart.com. Web: www.earnhart.com. Instagram: Earnhart.Associates.)