This short presentation introduces the OBSS and steps necessary to successfully implement it. It applies to all specialties. It particularly addresses the issue of procedures with zero SOSD and the issue of not being reimbursed for the OBSS overhead. This is part of a series.

1. Setting up an Office-Based Surgical Suite
June 4 2021
Jeffrey Restuccio, CPC, COC, MBA
Certified medical coder, auditor, and reimbursement consultant
http://www.IOECTR.com
ritecode@gmail.com
(901) 517-1705

2. The Issue
• Numerous surgical procedures can now be safely performed
in an Office-Based Surgical Suite instead of an ASC, HOPD or
hospital.
• The reimbursement challenge is that many surgical
procedures have a status indicator of "NA" in the “Non-Facility
NA INDICATOR” field in the 2021 Medicare PFSRVU database.
This means there is no additional reimbursement for the
OBSS.
• There are at least 97 orthopedic hand-and-wrist procedures,
that lend themselves to an OBSS, WALANT, and the
SOSD=zero; these procedures would require negotiation for
reimbursement with each carrier when performed in an OBSS.
www.IOECTR.com 2

3. Acronym Explanations
OBSS: Office-Based Surgical Suite. This means not at a facility (ASC,
HOPD, or hospital) and the Place of Service = 11.
OBS: Office-Based Surgery
IOECTR: In-Office Endoscopic Carpal Tunnel Release. This describes
Endoscopic Carpal Tunnel Release performed in an OBSS, typically
under WALANT.
WALANT: Wide Awake Local Anesthesia with No Tourniquet. This is
not a specific code but a new way to perform many hand and wrist
surgeries under local anesthesia.
SOSD: Site-of-Service Differential. This is the difference in
reimbursement for a procedure when performed in an office
(typically higher) versus a facility. Many procedures have zero SOSD.
www.IOECTR.com 3

4. OBSS Set Up (1 of 2)
In the Reimbursement Guidebook, available for free download
on www.IOECTR.com we offer assistance with the business-side
of evaluating an OBSS and the set up. We cover:
• Setting up an Office-Based Surgery Suite
• Registration and accreditation issues
• Patient Safety
• Benefits of IOECTR / WALANT / Office-Based CTR
• Research supporting WALANT, local anesthesia, OBS, and
IOECTR
• What is WALANT?
www.IOECTR.com 4

5. OBSS Set Up (2 of 2)
In the Reimbursement Guidebook we offer assistance with the
business side of evaluating an OBSS and the set up.
• Office Surgical Suite Protocols
• IOECTR Contract for Reimbursement
• Individual State Laws and OBSS
• OBS Equipment Inventory
• Contingency plans
• Marketing
• Feedback from clinics and surgeons.
www.IOECTR.com 5

6. Parting Remarks
• Some procedures pay more when performed in the office.
These have an SOSD; some pay hundreds more while others
pay less than $50. For example OCTR has an SOSD but only
pays $6.14 for the office overhead. ECTR has zero SOSD when
performed in the office.
• Always work with a healthcare attorney before setting up your
OBSS.
• Never bill a facility charge for an OBSS; the Place of Service =
11 (office). An office is never a facility—even if you are
performing surgeries.
• Be prepared to negotiate with your top carriers for the office
overhead expenses (NON-FAC PE).
www.IOECTR.com 6

7. Hold Harmless Statement
• This coding and reimbursement information is provided for
educational purposes only.
• It is not intended to represent the only, or necessarily the best,
coding advice for the situations discussed, but rather represents an
approach, view, statement, or opinion that may be helpful to
persons responsible for coding and billing in a medical clinic.
• The statements made in this presentation should not be construed
as policy or procedure, nor as standards of care. State requirements
and policies change all the time; while every effort was made to
ensure accuracy, the author makes no representations and/or
warranties, express or implied, regarding the accuracy of the
information contained in this presentation and disclaims any liability
or responsibility for any consequences resulting from or otherwise
related to any use of, or reliance on this information.
www.IOECTR.com 7

8. Setting up an OBSS
June 4 2021
Jeffrey Restuccio, CPC, COC, MBA
Certified medical coder, auditor, and reimbursement consultant
http://www.IOECTR.com
ritecode@gmail.com
(901) 517-1705