Reporting Ambulatory Surgery in New York State

SPARCS Reporting Requirement for Ambulatory Surgery

The definition of Ambulatory Surgery has changed for discharges reported to SPARCS effective April 2007.

Effective March 28, 2007, Paragraph (1) of subdivision (d) of Section 400.18 of Title 10 (Health) of the Official Compilation of Codes, Rules, and Regulations of the State of New York (NYCRR) is amended to read as follows:

  • (1) All facilities licensed under article 28 of the Public Health Law that provide ambulatory surgery services shall submit in an electronic format for each patient surgical visit that requires a stay of less than 24 hours any procedure listed in the American Medical Association Current Procedural Terminology (CPT) as prescribed by the commissioner to be maintained on an annual basis, including but not limited to all procedures in the Surgery Section of CPT.

The Ambulatory Surgery Procedure Code list (effective 4/1/2007) for SPARCS Reporting of the above is as follows:

CPT-4 Category Code Range
Surgery 10021 - 69990
Medicine
Cardiovascular 92973 - 92998
Cardiac Catheterization 93501 - 93581
Intra-cardiac Electrophysiological Procedures/Studies 93600 - 93662

Previous Definition of NYS Collected Ambulatory Surgery Data

Brief Description

Sections 755.1 and 405.20(d) define an ambulatory surgery service as one organized to provide surgical procedures performed for safety reasons in an operating room on anesthetized patients requiring a stay of less than 24 hours. The regulations also explicitly exclude outpatient surgical procedures that can be performed safely in an outpatient treatment room or a private physician's office. These regulations are employed in the licensure of freestanding and hospital-based ambulatory surgery centers, in the oversight and surveillance of these facilities by the Department, and are the foundation for Medicaid in reimbursement (the actual reimbursement methodology for ambulatory surgery is found in Part 86-4.40). These rules also served as the basis for the reporting of ambulatory surgical procedures to the Statewide Planning and Research Cooperative System (SPARCS) as required by Section 400.18 since the mid 1980's.

Historical Reason behind the Change

Since these regulations defining ambulatory surgery were enacted nearly twenty years ago, progress in medical technology, surgical technique, and medical practice have resulted in a dramatic broadening of site of service, with a shift from the operating suite to procedure rooms, physician offices, and outpatient clinics. This change has left the Department with a set of regulations that were dramatically out of step with modern medical practice. Consequently, the stipulation in the current Sections 755.1 and 405.20(d) that ambulatory surgical procedures are those performed in an operating room in effect narrows the definition of ambulatory surgery by excluding a large number of surgical procedures increasingly performed in non-operating room settings.

Because the SPARCS reporting requirements in Section 400.18 employed the definition of ambulatory surgery set forth in Sections 755.1 and 405.20(d), operators of both hospital-based and freestanding ambulatory surgery centers (ASCs) were required to report to SPARCS only those procedures performed in an operating room. This resulted in the extensive underreporting of ambulatory surgical procedures to SPARCS. This in effect hampered the Department's efforts to develop appropriate mechanisms for quality assurance of ambulatory surgical procedures carried out in Article 28 facilities. By changing the definition to explicitly state the codes necessary for reporting ambulatory surgery procedures, the Department will be able to conduct research into the epidemiology of diseases and conditions amenable to surgical intervention and to identify changes and trends in surgical practice over time.

Change Requested in Definition

Because Sections 755.1 and 405.20(d) are closely tied to reimbursement regulations and methodologies for ambulatory surgery reimbursement in Medicaid, they cannot be amended without statutory change to Medicaid reimbursement structures. However, because of the urgent need to amend SPARCS reporting requirements for ambulatory surgical procedures, the Department proceeded with revision of Section 400.18, which did not require legislative action. The revisions to Section 400.18 broadened the definition of ambulatory surgery for SPARCS reporting purposes only. The definition of ambulatory surgery in Sections 755.1 and 405.20(d) remains unchanged until legislation to amend the Medicaid formula for ambulatory surgery is proposed and passed.

The broader definition of ambulatory surgery in the revisions to Section 400.18 removes the stipulations that ambulatory surgical procedures are those that must be performed for safety reasons in an operating room and on anesthetized patients. It further removes the exclusion of those outpatient surgical procedures that can be performed safely in an outpatient treatment room or other non-operatory setting. The revisions retain the stipulation that ambulatory surgical procedures require a stay of less than 24 hours' duration.

The revised rule adds a list of American Medical Association's Current Procedural Terminology (CPT) procedure codes; this list is to be prescribed by the Commissioner and maintained on an annual basis, including but not limited to, all procedures in the Surgery Section of CPT. Thus, the new definition of ambulatory surgery services for SPARCS reporting purposes covers all CPT surgery procedures performed in hospital-based and freestanding Article 28 ambulatory surgery facilities, regardless of whether carried out in an operating room, an outpatient treatment room, a procedure room or other setting. It also covers other procedures, as prescribed by the Commissioner, which may not currently be defined as "surgery". Examples are certain cardiac catheterization procedures and some procedures in the emergent field of radiosurgery. The scope of the definition will help ensure the reporting to SPARCS of all ambulatory surgical procedures conducted in Article 28 facilities, even as progress in medical treatment results in the continued migration of these procedures from the traditional operating room to other venues.