ASC Quality Reporting Program Manual Released

The Centers for Medicare and Medicaid Services (CMS) recently released a new version (v. 1.0a) of the ASC Quality Measures Specifications Manual. It goes into effect for reporting on services provided on or after October 1, 2012. The new version clarifies that ASCs, regardless of medical specialty or procedures performed, must report on all five measures from October 1, 2012 to December 31, 2012. Crucially, those ASCs that do not report on the 5 measures over the time frame above will get a full 2 percent reduction in their 2014 Medicare Payments.[1]

The recent clarification concerns Measure #ASC-5: Prophylactic Intravenous (IV) Antibiotic Timing. Many ophthalmology-specific ASCs felt that ASC-5 did not apply when no IV antibiotic was indicated; CMS instructions for reporting in that scenario were not specific. On page 5 of the revision, CMS clarified: “ASC-5 applies to all ASCs regardless of specialty or procedure performed.”

As a result, ophthalmology-specific ASCs will commonly report a minimum of two codes:

· G8907: Patient documented not to have experienced any of the following events

1. burn prior to discharge

2. fall within the facility

3. wrong site, wrong side, wrong patient, wrong procedure or wrong implant event

4. hospital transfer or admission upon discharge from the facility

· G8918: Patient without preoperative order for IV antibiotic SSI prophylaxis.

If any of the “never-events” listed in G8907 (burn, fall, wrong site, transfer) do occur, the ASC must report on each of the four corresponding G-codes as “occurred or did not occur”. Codes G8916, G8917 or G8918 would need to be individually reported, resulting in five G-codes on the claim.[2] [1] QualityNet. Centers for Medicare and Medicaid. Ambulatory Surgical Center Quality Reporting Program. Quality Measures Specifications Manual. July 2012. (Link to manual here.)

[2] Federal Register final rule, Page 75400 (Link here.)

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