Prostate surgery reimbursement rises

Some other surgeries are hurt by new APCs

Critics of the proposed ambulatory payment classifications (APCs) suggest that the Health Care Financing Administration (HCFA) could have updated the APC proposal and allowed for new technologies.

HCFA did update data for three new procedures for men with prostate problems.

For example, one of these procedures is currently reimbursed at $595 and is listed under CPT code 52601: Transurethral electrosurgical resection of the prostate, including control of postoperative bleeding, complete. The proposed APC code of 524 defines it as a Level IV cystourethroscopy and other genitourinary procedures, with a reimbursement payment of $1,131, a $536 increase.

However, HCFA's proposed APCs will likely have a negative effect on many more surgical procedures, two surgery center executives say.

The proposed APCs may negatively affect ophthalmology surgery centers because of large decreases in reimbursement for cataract and other procedures, says Mark Mayo, executive director of the Illinois Freestanding Surgery Center Association and director of Valley Ambulatory Surgery Center in St. Charles, IL.

Ken McDonald, president and chief executive officer of AmSurg Corp. of Nashville, TN, says two of the fields most impacted are gastroenterology and ophthalmology. AmSurg is a publicly traded outpatient surgery center company that specializes in single-specialty surgery centers.

The solution to all of the reimbursement problems with APCs would be for HCFA to make changes in its methodology, McDonald says.

"The real key is to see if we can get HCFA to work with the industry to come up with viable methodology to use correct data in making the right changes," McDonald adds.