The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) recognizes the existence of lists of surgical procedures that may be appropriately performed in an ambulatory surgical center (ASC) setting. The AAO-HNS does not develop or provide these lists of otolaryngologic procedures to the Centers for Medicare and Medicaid Services (CMS), however the Academy does support general standards for services covered in the ASC setting set forth in the Federal Register, Vol. 77, page 45159, July 30, 2012, and listed below:
Under § 416.2 and § 416.166 of the regulations, subject to certain exclusions, covered surgical procedures are surgical procedures that are separately paid under the OPPS, that would not be expected to pose a significant risk to beneficiary safety when performed in an ASC, and that would not be expected to require active medical monitoring and care at midnight following the procedure (‘‘overnight stay’’).
It is important to note that there are numerous exclusions to covered services in the ASC setting which are outlined under 42 CFR §416.166 and listed below:
General exclusions. Notwithstanding paragraph of this section, covered surgical procedures do not include those surgical procedures that—
1. Generally result in extensive blood loss;
2. Require major or prolonged invasion of body cavities;
3. Directly involve major blood vessels;
4. Are generally emergent or life-threatening in nature;
5. Commonly require systemic thrombolytic therapy;
6. Are designated as requiring inpatient care under § 419.22(n) of this subchapter;
7. Can only be reported using a CPT unlisted surgical procedure code; or
8. Are otherwise excluded under § 411.15 of this subchapter.
Important Disclaimer Notice
Position statements are approved by the American Academy of Otolaryngology—Head and Neck Surgery, Inc. or Foundation (AAO-HNS/F) Boards of Directors and are typically generated from AAO-HNS/F committees. Once approved by the Academy or Foundation Board of Directors, they become official position statements and are added to the existing position statement library. In no sense do they represent a standard of care. The applicability of position statements, as guidance for a procedure, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these clinical position statements will not ensure successful treatment in every situation. As with all AAO-HNS/F guidance, this position statement should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results.
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