Medicare last month added 65 codes to the ASC Procedure List. Here's a look at some of the more exciting ones. Payment groups for these procedures are in parentheses.

• 29873 (3) Knee arthroscopy with lateral release

Lateral release is performed when the patella becomes misaligned and doesn't track properly; tracking describes the movement of the patella with the knee. Lateral release involves cutting the tight lateral ligaments to allow for normal tracking of the patella. The surgeon first makes a small incision in the retinaculum through the arthroscope. He then cuts the tight ligaments on the outside (lateral side) of the patella to allow it to slide toward the center of the femoral groove. These ligaments eventually heal with scar tissue that fills in the gap the surgery creates.

• 36475, 36476, 36478, 36479 (3) Endovenous vein ablation

These codes are distinguished by energy modalities and describe different means of endovenous vein obliteration. They all consist of percutaneous insertion of a catheter into the longer veins of the upper and lower extremities.

CPT 36475 is endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated.

CPT 36476 is endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; second and subsequent veins treated in a single extremity, each through separate access sites; list 36476 separately in addition to the code for the primary procedure.

CPT 36478 is endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; first vein treated.

CPT 36479 is endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; second and subsequent veins treated in a single extremity, each through separate access sites; list 36479 separately in addition to code for primary procedure.

Exclusionary parenthetical notes instruct that these codes aren't appropriately reported in addition to the needle or catheter introduction codes (36000-36005) endovenous ablation procedures of a different modality (36475-36479) venipuncture (36410, 36425) percutaneous trans-catheter occlusion code (37204) duplex extremity venous study codes (93970-93971) and ultrasound and fluoroscopic imaging codes 75894, 76000-76003, 76937, 76942, as the endovenous ablation procedure codes include all imaging guidance and monitoring. Endovenous ablation therapy requires imaging to direct this therapy.

These codes include ultrasound for access, ultrasound for guidance and monitoring, and in some cases fluoroscopy for negotiating the venous structures. Codes 93970 and 93971 are not appropriately reported in addition to codes 36475, 36476, 36478 and 36479 when performed at the same session to ensure proper occlusion of the vein. However, you may report codes 93970-93971 separately when performed as an independent diagnostic study on the same date of service.

Although percutaneous access is specified in the descriptor, the vein is occasionally accessed by way of a small cut down. If performed to achieve access, you can also include a small cut down in the procedure. Don't report this separately.

Append modifier -50 to the procedure code when you perform the procedure in both legs in one session.

• 51992, 57288 (5) Stress incontinence

CPT 51992 is a laparoscopic sling operation for stress incontinence (fascia or synthetic) CPT 57288 is a sling operation for stress incontinence (fascia or synthetic). When you perform a cystoscopy to confirm that the sling procedure was successful, don't report code 52000 (cystourethroscopy) in addition to code 57288. Assign code 57288 for the tension-free vaginal tape procedure.

• 65780 (5), 65781 (5), 65782 (5), 68371 (2) Ocular surface reconstruction

The techniques described in codes 65780-65782 represent new tissue transplants to the cornea for the treatment of severe corneal surface diseases.

CPT 65780 is ocular surface reconstruction; amniotic membrane transplantation. The amniotic membrane acts like a biological bandage to facilitate natural healing.

CPT 65781 is ocular surface reconstruction; limbal stem cell allograft (cadaveric or living donor). It provides new corneal epithelial stem cells to promote normal surface anatomy.

CPT 65782 is ocular surface reconstruction; limbal conjunctival autograft (includes obtaining graft). It involves dissection of a layer of the cornea extending onto the sclera beyond the limbus.

Codes 65780-65782 are differentiated first by the type of transplant materials used, either amniotic membranes (available from eye banks) or from stem cells derived from the conjunctiva of a donor (allograft) or from the patient's opposite eye (autograft). If the graft is taken from a living donor (allograft), the graft is attached first to the perilimbal area to produce epithelial stem cells, which will be transplanted into the damaged corneal surface. Code 68371 describes harvesting the conjunctival graft from the donor.

Until 2008...
Medicare is expected to adopt an exclusionary list that specifies what procedures ASCs can't (rather than can) perform, but not before 2008. Until then, you're left to figure out ways to optimize payment on the 2,464 CPTs CMS reimburses surgical centers to perform.