As ambulatory surgery centers start reporting Medicare quality on Oct. 1, 2012, they are taking on a new responsibility. Staffs are now expected to report G codes on a few outcomes and process of care – a list that will be expanded later on. ASCs that fail to report G codes on a minimum number of Medicare claims will face a financial penalty of 2% of the Medicare payments starting in 2014. 

To be successful with this new duty, staff will have to learn how to select the correct G codes and keep on top of Medicare cases to make sure the right G codes are reported. Since this is a new function, you will need to designate which personnel in your facility will report the G codes. 

G codes: the basics   

A total of 12 G codes cover five claims-based measures. In addition to one process-of-care measure – administration of IV antibiotics – there are four adverse outcomes to report: patient burn, patient fall, transfer to the hospital and wrong site, wrong side, wrong patient, wrong procedure or wrong implant.

When you report G codes, you will need to use at least two per case. Typically, you will be using G 8907, to indicate that none of the four adverse events occurred, and then you will need to choose a second code covering use of the prophylactic IV antibiotic. You will be choosing from among three possibilities – G 8916, 8917 or 8918 – indicating that the antibiotic was given on time, not given on time or not given at all.

How do you connect QAPI, Infection Control, and Risk Management in your surgery center?