G-CODES? Medicare will pay surgical centers that fail to report quality data G-codes a reduced rate in 2014.

Beginning next month, freestanding surgical centers must start reporting data on 5 quality measures on their Medicare claims or face future Medicare payment reductions. The quality measures include 4 adverse events — patient burn, patient fall, wrong site/side/patient/procedure/implant and hospital admission/transfer — and the timing of prophylactic IV antibiotic administration.

This is no voluntary program. Medicare will penalize ASCs that fail to report the quality data G-codes on at least 50% (this percentage may increase in future years) of their Medicare claims between Oct. 1 and Dec. 31, 2012. In 2014, CMS will reduce the ASC conversion factor for noncompliant ASCs by 2% and pay all their Medicare claims at a lower rate. Failure to report in subsequent years will affect that ASC's future years' payments to the same extent.

ASCs should include the G-codes only on claims where traditional Medicare is the primary payor. When filing claims to Medicare HMOs and Medicaid plans, ASCs don't need to use the G-codes unless they receive specific notification from the plan that G-codes are required. Only freestanding ASCs that are billing with their own CMS Certification Numbers (CCN) are required to participate. An ASC that is part of a hospital's regional outpatient facility and billing under the hospital's CCN is exempt.

Either 2 or 5 G-codes
The number of G-codes you'll report on the claim form will always be either 2 or 5:

• On all claims, you'll report a G-code (G8916, G8917 or G8918) that corresponds to the patient's experience with prophylactic IV antibiotic.
• You'll report an additional G-code, G-8907, if the patient doesn't experience any of the 4 specific adverse events: patient burn, patient fall, wrong site/side/patient/procedure/implant and hospital transfer/admission.
• You'll report an additional 4 G-codes, each corresponding to 1 of the 4 specific adverse events, if the patient experiences 1 or more of the adverse events.

The more often you're able to report G8907 and G8916, the better. This means there were no adverse events and you administered the antibiotic on time.

Give your business office staff a copy of "Quality Data G-Codes" to post or keep by their side when they're inserting the new G-codes onto Medicare claim forms. You'll have to figure out a way to communicate which of the new G-codes to use for each case to your billers.

The G-codes follow the surgery and implant procedure code(s) in box 24D of the CMS-1500 claim form. The submitted charge field cannot be blank. The line-item charge should be the numeral 0 (zero). Dollar signs ($) or decimal points aren't accepted. If your system doesn't allow a zero line-item charge, you can substitute a nominal amount; the beneficiary is not liable for this nominal amount.

Transparency
CMS will make these data reports available to the public. The results could either demonstrate the high-quality care that ASCs provide or tarnish the clinical reputation of surgical centers. ASCs could take a PR hit if only a fraction of ASCs report data or if those that do report poor performance on the quality measures. It's not inconceivable that Medicare, as it does with hospitals, would withhold payments to ASCs for such adverse events as burns and falls. The Ambulatory Surgery Center Association is encouraging ASCs to focus not only on reporting successfully, but also on achieving high levels of performance on each measure.

2 or 5 G-CODES The number of G-codes you'll report on the CMS-1500 claim form will always be 2 or 5.

Quality Data G-Codes

Here are the quality data G-codes that Medicare released earlier this year to report the 5 measures selected for the initial year of the mandatory quality reporting program for ambulatory surgical centers. Two reporting measures are already in place for 2013: safe surgery checklist use in 2012 and 2012 volume of certain procedures. For a detailed list of the quality data G-codes, visit ascassociation.org/gcodes.

Corresponding Quality Measure	G-code
If no adverse events occurred, report the following:
All 4 adverse events did not occur	G8907

If one or more adverse events occurred, report 4 of the following:
Patient burn	G8908
Patient burn did not occur	G8909
Patient fall in ASC facility	G8910
Patient fall in ASC facility did not occur	G8911
Wrong site/side/patient/procedure/implant	G8912
Wrong site/side/patient/procedure/implant did not occur	G8913
Hospital transfer/admission	G8914
Hospital transfer/admission did not occur	G8915

Always report one of the following:
Prophylactic IV antibiotic initiated on time	G8916
Prophylactic IV antibiotic not initiated on time	G8917
Patient without pre-operative order for prophylactic IV antibiotic	G8918