Take This Quiz To Find Out If Your Asc Coding Skills Are Top-Notch
b>Are you a gold-star Ambulatory Surgery Center (ASC) coder?
Some practices code for services performed in ASCs every day, while others are just getting started. To find out how much you know about ambulatory surgery center coding and billing procedures, take this quick quiz. After that, click the ‘Full Article' button to check how you fared.
Question 1:
Physician carried out a non-approved service?
We came to know recently that our Medicare payer will reject the ASC's charges for any procedures are not on the ASC's list of approved services; however, what happens if the physician carries out a non-approved service anyway? How can we collect for our portion of the charges?
Hint: Visit (www.cms.hhs.gov/ASCpayment) for a list of CMS-approved ASC procedures.
Question 2:
Do you require modifiers 78 and &79?
I code for an ambulatory surgery center and my payer will not reimburse me for claims with modifiers 78 (Return to the operating room for a related procedure during the postoperative period) and/or modifier 79 (Unrelated procedure or service by the same physician during the postoperative period) appended to them. Should we appeal here?
Question 3:
Should you depend on all physician code selection?
Our ASC requires the physician to dictate his CPT codes directly into the operative report. They say that this way the surgeon and the ASC are sure to report the same code as one another. But as per my experience, I find that our surgeon does not always choose the right code; as such, I am uneasy about this. Should we toe the ASC's advice and have the physician choose the codes, or is there another way that our codes can keep up with the ASC-billed codes?
Question 4:
How should we append modifier SG?
When I bill services carried out in an ASC, I know that I must go for modifier SG (ASC facility service) to the CPT code. However, does this go to the first code, second code, last code, and the like?
If you're ready to check your work, press ‘full article' and tally your score.
Question 1:
Physician carried out a non-approved service?
Answer 1: Once in a while, the doctor will carry out a procedure in the ASC that Medicare doesn't include on its list of approved ASC services. The ASC cannot ask the patient to sign an advance beneficiary notice (ABN) for a service that's not on the approved list; nor can the ASC bill the Medicare patient for any unpaid balance. But, the doctor can still collect.
"When physicians perform procedures not on the Medicare-approved ASC list, they're reimbursed at the higher practice expense RVU rate, Deb Bridges, CPC-H, with University Suburban Health Center in South Euclid, Ohio says.
"CMS stated in Transmittal B-01-43 that any ASC-performed procedure is payable. Under those circumstances, physicians are paid at a higher rate and the ASC is deemed as the physician's office," Bridges advises.
The good news is: Bridges says, "Since the transition to the new payment system, it's difficult to find a procedure that isn't allowed in the ASC." "We hardly, if ever, have that problem anymore."
Question 2: Do you require modifiers 78 and &79?
Answer 2: The ASC's global period for all procedures carried out in the facility is 24 hours. Most of the procedures carried out in ASCs have a global period of 10 or 90 days, but that global period applies to the operating physician's claims, and not the facility's claims.
As such, ASC coders will rarely need to use modifiers 78 or 79. One of the unusual cases when you would use these modifiers would be if a patient underwent a procedure in the ASC and went home to rest. That afternoon, while recovering, the patient started to hemorrhage and called the surgeon.
The surgeon resent the patient to the OP to curb the hemorrhage. If the patient went back into the OR at the same ASC for a procedure the next day and it was past 24 hours since the ending of the first procedure carried out the day before, the ASC doesn't need to make use of modifiers 78 and 79 to their claim.
Question 3:
Should you depend on all physician code selections?
Answer 3: The coder should not blindly trust the physician's coding recommendations without also reading the note to confirm the code choices.
Margaret T. Atkinson, BS, CPC, RMC, business manager with Centennial SurgeryCenter in Vorhees, N.J. says, "We don't have one dictation system that allows doctors to dictate the CPT codes; but we ignore the physician codes and code based on what's actually documented in the operative record," adding, "As coders, we know that the actual body of the note must support the CPT codes and most surgeons are not savvy or are up to date coding rules and guidelines."
Tip: Atkinson says, "Our ASC receives the operative note a bit earlier than the physician's offices." "As such, we code the note for them (including physician modifiers) and fax it back to them for billing. It's a perk for them to schedule the cases here as the coding is done for them. In the long run, it saves their staff time and money. As far as the benefit to ASC is concerned, we're sure that there'll be no reason for the payer to delay payment for coding issues since we'll all be on the same page."
Question 4:
How should we append modifier SG?
Answer 4: You no longer need to append modifier SG (ASC facility service) on the claim when you bill Medicare for any service that your surgeon carries out in an ASC.
According to CMS Transmittal 1410, "Effective for services on or after January 1, 2008, the SG modifier is no longer applicable for Medicare services.
Some practices code for services performed in ASCs every day, while others are just getting started. To find out how much you know about ambulatory surgery center coding and billing procedures, take this quick quiz. After that, click the ‘Full Article' button to check how you fared.
Question 1:
Physician carried out a non-approved service?
We came to know recently that our Medicare payer will reject the ASC's charges for any procedures are not on the ASC's list of approved services; however, what happens if the physician carries out a non-approved service anyway? How can we collect for our portion of the charges?
Hint: Visit (www.cms.hhs.gov/ASCpayment) for a list of CMS-approved ASC procedures.
Question 2:
Do you require modifiers 78 and &79?
I code for an ambulatory surgery center and my payer will not reimburse me for claims with modifiers 78 (Return to the operating room for a related procedure during the postoperative period) and/or modifier 79 (Unrelated procedure or service by the same physician during the postoperative period) appended to them. Should we appeal here?
Question 3:
Should you depend on all physician code selection?
Our ASC requires the physician to dictate his CPT codes directly into the operative report. They say that this way the surgeon and the ASC are sure to report the same code as one another. But as per my experience, I find that our surgeon does not always choose the right code; as such, I am uneasy about this. Should we toe the ASC's advice and have the physician choose the codes, or is there another way that our codes can keep up with the ASC-billed codes?
Question 4:
How should we append modifier SG?
When I bill services carried out in an ASC, I know that I must go for modifier SG (ASC facility service) to the CPT code. However, does this go to the first code, second code, last code, and the like?
If you're ready to check your work, press ‘full article' and tally your score.
Question 1:
Physician carried out a non-approved service?
Answer 1: Once in a while, the doctor will carry out a procedure in the ASC that Medicare doesn't include on its list of approved ASC services. The ASC cannot ask the patient to sign an advance beneficiary notice (ABN) for a service that's not on the approved list; nor can the ASC bill the Medicare patient for any unpaid balance. But, the doctor can still collect.
"When physicians perform procedures not on the Medicare-approved ASC list, they're reimbursed at the higher practice expense RVU rate, Deb Bridges, CPC-H, with University Suburban Health Center in South Euclid, Ohio says.
"CMS stated in Transmittal B-01-43 that any ASC-performed procedure is payable. Under those circumstances, physicians are paid at a higher rate and the ASC is deemed as the physician's office," Bridges advises.
The good news is: Bridges says, "Since the transition to the new payment system, it's difficult to find a procedure that isn't allowed in the ASC." "We hardly, if ever, have that problem anymore."
Question 2: Do you require modifiers 78 and &79?
Answer 2: The ASC's global period for all procedures carried out in the facility is 24 hours. Most of the procedures carried out in ASCs have a global period of 10 or 90 days, but that global period applies to the operating physician's claims, and not the facility's claims.
As such, ASC coders will rarely need to use modifiers 78 or 79. One of the unusual cases when you would use these modifiers would be if a patient underwent a procedure in the ASC and went home to rest. That afternoon, while recovering, the patient started to hemorrhage and called the surgeon.
The surgeon resent the patient to the OP to curb the hemorrhage. If the patient went back into the OR at the same ASC for a procedure the next day and it was past 24 hours since the ending of the first procedure carried out the day before, the ASC doesn't need to make use of modifiers 78 and 79 to their claim.
Question 3:
Should you depend on all physician code selections?
Answer 3: The coder should not blindly trust the physician's coding recommendations without also reading the note to confirm the code choices.
Margaret T. Atkinson, BS, CPC, RMC, business manager with Centennial SurgeryCenter in Vorhees, N.J. says, "We don't have one dictation system that allows doctors to dictate the CPT codes; but we ignore the physician codes and code based on what's actually documented in the operative record," adding, "As coders, we know that the actual body of the note must support the CPT codes and most surgeons are not savvy or are up to date coding rules and guidelines."
Tip: Atkinson says, "Our ASC receives the operative note a bit earlier than the physician's offices." "As such, we code the note for them (including physician modifiers) and fax it back to them for billing. It's a perk for them to schedule the cases here as the coding is done for them. In the long run, it saves their staff time and money. As far as the benefit to ASC is concerned, we're sure that there'll be no reason for the payer to delay payment for coding issues since we'll all be on the same page."
Question 4:
How should we append modifier SG?
Answer 4: You no longer need to append modifier SG (ASC facility service) on the claim when you bill Medicare for any service that your surgeon carries out in an ASC.
According to CMS Transmittal 1410, "Effective for services on or after January 1, 2008, the SG modifier is no longer applicable for Medicare services.
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