Part B Insider (Multispecialty) Coding Alert

Published on Sat Jul 04, 2009 PDF

Hint: Your physician may still be able to collect for non-ASC-approved procedures, but the ASC can't.

Some practices code for services performed in ambulatory surgery centers (ASCs) every day, while others are just getting started.

To determine how much you know about coding and billing for ASC procedures, take this quick quiz. Then, turn to page 212 to find out how you fared.

Question 1: We recently learned that our Medicare payer will deny the ASC's charges for any procedures that aren't on the ASC's list of approved services, but what happens if the physician performs a nonapproved service anyway? How can we collect for our portion of the charges?

Question 2: I code for an ASC, and my payer won't reimburse me for claims with modifiers 78 (Return to the operating room for a related procedure during the postoperative period) and/or 79 (Unrelated procedure or service by the same physician during the postoperative period) appended to them. Should we appeal?

Question 3: Our ASC requires the physician to dictate his CPT codes directly into the operative report. They tell us that this way, the surgeon and the ASC are sure to report the same code as one another.

But in my experience, I find that our surgeon doesn't always select the correct code, so I'm uneasy about this. Should we follow the ASC's advice and have the physician select the codes, or is there another way that our codes can match the ASCbilled codes?

Question 4: I know that when I bill services performed in an ASC, I must append modifier SG (ASC facility service) to the CPT code. But does this go on the first code, second code, last code, etc.?

Ready to check your work? Flip to page 212 and tally your score.