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Second Opinions > Conditions for Coverage CMS 416.2

Conditions for Coverage CMS 416.2

We recently had deemed AAAHC survey. We are disputing their finding that we are in violation of 416.2 for performing bandage changes, which also serve as an evaluation for postoperative infection on day 7, and wound checks prior to dismissing patients to referring physicians. All of these are within global period and without any charges to CMS. What is your experience?

Started by: L R (Medical Director/Chief Surgeon) at January 9, 2012 (1:01 pm)

Comments and Responses

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You are in violation of 416.2 because you are not using your ASC for just an ASC and are co-mingling your practice and your facility. It is quite clear when you read Appendix L of the State Operations Manual edition 12-2011. It is also the ASC's responsibility to follow up on the with every surgeon whether their practice is in the same building on whether they have had infection or complications. Using your ASC to acheive this requirement does not meet the requirement.

Kathleen B. (Director, Surgical Services/Director of Nursing) at July 5, 2012 (4:32 pm)

Our ASC and practice are under the same roof yet separated by a fire wall. In instances when all of our exam rooms are full and we have a patient waiting, it is difficult to impart a rational explanation to the nurses and physicians as to why the patient cannot be taken into the preop area of the ASC for a "quick postop/recheck/suture removal" etc. The space is available and empty, yet the nurse is not able to utilize the area. The patient has to wait for a room in the practice to become available. It seems ridiculous, especially when the surgical procedure done on the patient was cosmetic in nature and there are no charges related to follow up appointments.

Mary Haskins (Director, Surgical Services/Director of Nursing) at April 10, 2012 (8:43 am) [last edited on April 20, 2012 (8:51 am)]

Medicare Conditions for Coverage 416.2 defines an ambulatory surgical center or ASC as "any distinct entity that operates exclusively for the purpose of providing surgical services to patients not requiring hospitalization" and in the interpretive guidelines states "The ASC must offer only surgical services. Separate ancillary services that are not integral to the surgical services, i.e., those furnished immediately before, during or immediately after a surgical procedure, may be provided. The ASC may not, however, offer services unrelated to the surgeries it performs."

Bandage changes, regardless of the purpose of evaluation for postoperative infection or otherwise, fall outside of the use of the term "immediately" in the interpretive guidelines. "Global period" for billing purposes relates to the physician's fee and not the facility. There is no "global period" relating to billing and charges for an ASC nor is there an appropriate modifier that would append to a charge for such services. If patients are coming back to your clinic for a dressing change 7 days post-operatively and are not there for surgical services (i.e., bandage changes), it could easily be interpreted that the facility is acting as a convenient medical office for the surgeon and performing office related tasks not commonly associated with ASCs. CMS is quite clear on the separation required by ASCs and a physician's office.

Thomas D. (Medical Director/Chief Surgeon) at March 6, 2012 (5:51 pm)

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