Report Shows Disc Arthroplasty Top Billed Code in An ASC

F.J. Thomas

Sarasota, FL (WorkersCompensation.com) – For many years only a certain number of surgical procedures were approved for an Ambulatory surgery center (ASC) setting, due to outcomes and safety concerns. With more procedures being approved for an ambulatory setting, ASCs have proven to not only be safe, but a cost effective alternative as well.

Healthcare analytics company Definitive Healthcare reviewed 2019 ASC claims data from clearinghouses across the country for multiple payers and ranked the top 25 procedures by cost and by volume.

The most expensive procedure by average per claims was a breast reconstruction code S2067, for a total of $14,535,855 in charges for 109 claims, averaging out to $133,356 per procedure.

Heart surgery code C1882 for Cardioverter-defibrillator came in second at a total of $14,899,027 in charges for 134 claims, averaging out to $111,187 per claim.

Cartilage implant code J7330 for Autologous cultured chondrocytes implants came in third at a total of $47,451,368 in charges for 555 procedures, averaging out to $85,498 per claim.

The number one procedure by total charges was spinal code 0375T for a disc arthroplasty. Billed charges totaled $648,868 for a total of 15 procedures, averaging out to $43,258 per claim. By average cost per claim, the code ranked 23rd.

Endoskeletal lower extremity prosthesis code L5856 ranked second by total charges, and 25th by average cost per claim. Billed charges totaled $682,054 for 16 procedures, equating to $42,628 per claim.

Cancer drug J0202, injectable alemtuzumab, came in at third by total charges. There were 16 claims for a total of $948,000 in billed charges, averaging out to $59,250 per claim. The code ranked 13th by cost per claim.

When ranked by number of procedures billed, the top high priced code was cardiac code 33249 for insertion or removal of a permanent pacing cardioverter-defibrillator system, with 2,968 claims billed. The average cost was $56,626. Neurostimulator implant code L8687 came in second with 2,318 claims, and an average cost per claim of $50,066. Cochlear device implant code 69930 came in third with 1,515 claims, averaging out to $50,570 per claim.

According to the data from Definitive Health, the most common code billed is cataract removal code 66984 with lens implantation. The total number of claims billed with that code was 1,251,164 for charges totaling $1,203,836,786, and averaging $962 per claim. The code also ranked number one by billed charges as well.

Botox injection code J0585 came in second with 894,793 claims totaling $5,462,609 in billed charges, averaging out to $6.10 per claim. Biopsy code 43239 came in third with 527,817 claims billed for $166,052,761 in charges, averaging out to $315 per claim.

The full report is available on the Definitive Health website.

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