New Medicare Quality Reporting for Ambulatory Surgery Centers (ASC)

On October 1, 2012,  ASCs will be required to start reporting quality data G-codes on 5 quality measures or face future (2014) Medicare payment reductions. ASCs will report the G-codes corresponding to the Medicare patient’s experience depending on the procedure code billed.

The number of G-codes the offices report will either be 2 or 5:

•  One G-code that corresponds to the patient’s experience regarding IV antibiotic prophylaxis will be reported on all claims (G-codes G8916, G8917 or G8918). See attached G-code listing for more information.

•  An additional G-code G8907 will be reported if the patient does not experience any of the 4 specific adverse events (patient burn, patient fall, wrong site/patient/procedure/implant and hospital transfer/admission).An additional 4 G-codes, each corresponding to one of the 4 specific adverse events, need to be reported if the patient does experience one or more of the adverse events.

•  An additional 4 G-codes, each corresponding to one of the 4 specific adverse events, need to be reported if the patient does experience one or more of the adverse events.

NOTE: ASCs should only include the G-codes on claims where Medicare is the primary payer. It is not
until January 1, 2013 that the G-codes are needed on claims where Medicare is either the primary or
secondary payer.

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