1. K

    Wiki Skin Substitutes @ ASC's

    Hello, Wondering if anyone can clarify on the appropriateness of billing skin substitutes at an ASC. We have used 15777 (implantation of biologic implant) on breast cases and in the past have billed the HCPCS Q4116 or Q4128 as well. In a recent issue of MLN matters, I read that ASC's should...
  2. bekka

    Wiki Medicare billing dental

    Is anyone billing the new accepted dental codes to Medicare with success on more than one line item? For example we billed a D7210- 4 times each separate line and they are paying one and denying the others as duplicates? Any one have any suggestions. No matter the code they are only paying one...
  3. S

    Wiki ASC- Cardiology for C7517

    Does anyone else code for an cardiology ASC that I can go over C7517- heart cath with angiogram? I don't agree with our dictation in order to be able to bill this code. Thank you!
  4. C

    Wiki KX MOD in a ASC

    I code for the facility not the professional services. I am being asked to review a claim that denied due to Pt has meet max benefits for the year. The AR rep is stating they were advised that this case scenario may meet the requirements to add the KX modifier. When would it be appropriate to...
  5. T

    Wiki Modifier 53 for ASC Procedure?

    I do physician billing (not billing for the facility) and the doctor documented that after anesthesia was administered the patient's "heart rate increased to 120-130 with some decreased bp so procedure not preformed, will need cardiology eval and may consider trusp under local w cognitive...
  6. K

    Wiki UPT Lab Pre-Procedure

    Patient has Glucose or UPT (pregnancy test) prior to procedure in ASC (POS 24)- Can this be billed on either prof or facility claim for procedure?
  7. K

    Wiki ASC Moderate Sedation

    Billing for both ASC (POS 24) as well as professional/MD: Moderate sedation (99152, 99153) was performed in the ASC, and I understand that it is included in the ASC pricing for primary procedure and should not be included on the facility claim however, my question is, could 99152 billed on the...
  8. K

    Wiki ASC Discontinued Procedure

    Billing for both ASC (POS 24) as well as professional/MD: A patient that was checked in for a non-anesthesia procedure and was provided pre-procedure care (BP, Glucose, O2 monitoring), but the procedure was cancelled at provider's discretion due to patient's vitals at the time. The total time...
  9. D

    Wiki ASC Split Facility Bill

    A patient goes into a neighboring Outpatient Cardiac Cath facility for a cardiac Cath. One physician does the diagnostic Cath, leaves, another physician places a single stent. Each physician reports and bills their procedures. The facility sends two bills, coding for two separate facility...
  10. M

    Wiki multiple procedures-ASC coding question

    Where would you apply modifiers to these codes in the ASC setting? Only the 13132 paid. This is an Aetna claim. The denial does state the codes denied for the charges included in the contracted and/or case rate so I'm not sure if that's referring to a grouper for the ASC..? 11402 11442 13120...
  11. R

    Wiki billing part b for POS 24

    I'm completely lost over how to bill on the CMS1500 for our ASC/ Medicare part B... any help would be lovely. I have rendering physician and ordering physician, even though they're the same. TC also does not work. My EHR doesn't want to let me enter a TOS. So, please...
  12. M

    Wiki ASC fee schedules updates

    I've pulled the Addendum for Final ASC Covered Surgical Procedures for CY2019. 14301 is not listed. Does that mean they've deleted and don't consider that a procedure that is covered in ASC setting? It was on the 2018 list. 11402 isn't on the Jan addendum either.
  13. M

    Wiki fee schedule for procedures in ASC

    I've pulled the Addendum for Final ASC Covered Surgical Procedures for CY2019. 14301 is not listed. Does that mean they've deleted and don't consider that a procedure that is covered in ASC setting? It was on the 2018 list. 11402 isn't on the Jan addendum either.
  14. K

    Wiki 26 and TC modifier

    I work for a pain management physician who also owns an ASC where he performs some of his procedures. I an responsible for the coding for his practice and the ASC and need some help on this. If he perform a 64490 in the ASC do I append the TC modifier to the claim for the ASC and then for his...
  15. B

    Wiki Pneumatic Compression E0676 in ASC

    When used prophylactically to prevent DVT, is E0676 included in the global facility fee? I understand no for Medicare. What about private payers? When used based on comorbidities that might complicate the procedure, would it be covered in the facility fee for Medicare or private payers?
  16. S

    Wiki Bilateral Procedures for ASC

    Can someone please clarify how to bill bilateral procedures for ASC (Ambulatory Surgery Center)? I've heard that it varies between payers, but I just someone just told me that Medicare will not accept modifier -50 for ASC and that we have to bill -LT/-RT on separate line items. Is this correct...
  17. S

    Wiki X-ray billing help!

    I'm new to an ASC facility and when it comes to x-rays (almost always performed along with a surgery), I am told that we code professionally with -26 modifier but don't bill at all for the facility side. It was explained to me that x-rays are included in the global surgery package for...
  18. S

    Wiki Biller/Coder w/ ASC/SDS Expertise - Looking For FT Work (Remote or NW Houston, TX)

    Hello, I am a certified Medical Biller and Coder with expertise in multi-specialty Ambulatory Surgery Centers/Same Day Surgery looking for full time work either remotely or in Northwest Houston, TX. Willing to do Billing, Coding, or Both. Attached is my resume for your review.
  19. G

    Wiki Looking for reliable software that estimates Medicare pricing

    I'm looking for software that will, as accurately as possible, estimate Medicare pricing for outpatient hospital and ASC claims when coding has been added; something similar to the CMS PC pricer for inpatient claims. Maybe an APC grouper. Does anyone have any resources where I can find...
  20. H

    Wiki Where do I find the 2018 ASC medicare fee schedule

    I work in a specialist office and work in conjunction with an ASC. I have been having a very difficult time finding the 2018 Medicare ASC fee schedule. Where do I find it? Any assistance would be appreciated. Sorry for novice question; I'm still new to this.
  21. A

    Wiki hcfa1500 vs ub4

    I thought I had this figured until today. What codes, exactly, should be billed on a UB4 form and what codes, exactly should be billed on a HCFA 1500 when an ASC is doing the billing? I thought a UB 4 form was ONLY for the facility charge , supplies and drug codes, with the actual procedure...
  22. S

    Wiki Modifier 26

    I have a question? When billing for pathology services for a procedure that was done in POS 24 are we to apply the modifier 26? Our office is receiving denials when billing for the services with a global. The denial states that the technical component was covered under the facility charges. When...
  23. 5

    Wiki Puraply - skin grafts

  24. B

    Wiki Capsule Endoscopy Placement ASC Facility Billing

    Physician performed an EGD simply for the placement of the Pill Cam, no other diagnostic services performed. Pre-operative diagnosis is Iron Defiency Anemia & Esophageal Web Q39.4. Primary question is how to bill for ASC services? 43235? We normally bill for the PillCam in office 91110, but...
  25. B

    Wiki Premarin Cream Billing Reimbursement?

    Hello We have a doctor we are looking to do procedures at an ASC and is going to use Premarin vaginal cream during some surgical procedures. Is there a code to bill for the Premarin cream, possibly a J code? The ASC is trying to determine how they will get reimbursed for the cost of the cream...
  26. J

    Wiki Facility fee denials for gastro procedures in our physician owned ASC

    I am hoping to get some input/advice.. We are being denied ALL of our facility fee charges for our ASC from Medicaid due to "Taxonomy codes not supporting our CPTs." Our ASC is billing out with the taxonomy code for ambulatory surgery center, and a rep from Medicaid tells me that we should be...
  27. 2

    Wiki Certified Physican Surgery coder with 9 years experience looking for contract work

    CPC certified with 9 years experience in multispecialty physician coding surgeries, E/Ms, and denials including pain management, cardiac, cardiothoracic, neurology, ortho, OB/GYN, gastro, urology, podiatry, dermatology, anesthesia, family practice, peds, ENT. Surgery coding is my passion...
  28. S

    Wiki ASC Billings/ Coding

    Our surgery center bills for the ASC Facility fee and we have an Orthopedic surgeon who wants to do a 29827 (arthroscopic rotator cuff repair) and then have a Pain Management physician come into the OR and do a 64483 (lumbar transforaminal epidural) on the same patient, for a completely separate...
  29. S

    Wiki ASC Billing/ Coding

    Our surgery center bills for the ASC Facility fee and we have an Orthopedic surgeon who wants to do a 29827 (arthroscopic rotator cuff repair) and then have a Pain Management physician come into the OR and do a 64483 (lumbar transforaminal epidural) on the same patient, for a completely separate...
  30. P

    Wiki facility billing for SI joint with ultrasound

    Can anyone tell me if we are to use G0260 if the SI joint injection is using ultrasound for outpatient facilities and ASC? I understand physicians use 20611 but I can not find anything about the hospitals and ASC's.
  31. L

    Wiki NC Medicaid help please?

    We have an ENT dr that does procedures in our facility (ASC), we are having an issue when he does a T&A (42820) or Tympanostomy (69436) along with any 30802,30930, or 30140... We get paid by commercial carriers however NC Medicaid doesnt pay but for the primary procedure. I am thinking this is...
  32. L

    Wiki -TC Portion Pathology in ASC

    I'm new to both pathology and ASC billing. I have billed our -TC portion of the pathology that was done in our ASC. I billed 88305-TC with a POS of 24. I am being denied with Cigna for inconsistent modifier use and an Aetna denial because "treatment has been rendered by the payer to be...
  33. R

    Wiki Carefirst denial of codes 11422 and 11426

    Recently we have had claims denied for payment of Excision of benign lesions 11400 series. Dictation has been specific in documenting size and area of lesions. We are an ASC facility and these are ASC procedures. Has anyone else been denied payment for these procedures? or is Carefirst just...
  34. G

    Wiki 2016 Ambulatory Surgical Center Fee Schedule CBSA View???

    Looking for the fee schedule for ASC on Cahaba website and I can't find it yet. The physician fee schedule was made available today, but not ASC. I found all of the addendum, federal registry, RVU spreadsheet but not the fee schedule Any help appreciated!!
  35. G

    Wiki ASC Medicare Fee Schedule for Georgia???

    I know the physician fee schedule for 2016 just became available today, but I am looking for the ASC Fee Schedule for CBSA 10500?? I was able to find the Addendums, Federal Registry, RVU spreadsheet but I need the specific allowables. Thanks in advance!!
  36. S

    Wiki 99144 in an ASC

    My pain management doctor frequently performs procedures at an ASC and provides sedation (99144). However, I read a Q&A article in the September issue of Medicare Part B news ( that stated pain management doctors should not bill for...
  37. G

    Wiki Hcpc d codes for dental in asc

    Are you aware that the D codes are no longer in the HCPC? Does anyone bill Dental for ASC facility? Are you using HCPC D codes? According to BCBS of MN all ASC's should bill on the professional electronic claim format as of 07/01/09. BCBS MN will deny all ASC claims on an institutional...
  38. D

    Wiki discography work comp billing

    Does anyone out there do billing for discography for general work comp? If so what type of reimbursement do you get? We are an ASC, and I have a doctor who says that I am coding wrong, which I have researched until I am blue-in-the-face and have been told that I am coding correctly. We bill...
  39. G

    Wiki EGD with EMR for ASC

    Has anyone else in an ASC setting ever billed for an EGD with EMR (endoscopic mucosal resection) of a hemi-cercumferential area of distal barrett's due to intramucosal carcinoma? Please note that the devices is used by applyng a band to create a berry-like pseudopolyp which is then removed by...
  40. G

    Wiki Modifiers 62 and 80 for asc's

    Is it appropriate for an ASC to use modifiers 62 (two surgeons as primary performing distinct part of procedure) and/or 80 (assistance surgeon)? Based on the CPT Appendix A these Modifiers are not listed for ASC approval.;)
  41. B

    Wiki ASCs Bill Pre-Op Pain Block for Post-Op Pain?

    We are an ASC researching billing for pre-operative anesthesia for post-operative pain block, (e.g.: interscalene block). Anybody know what type of documentation is needed, (anesthesia note on op report or separate documentation by surgeon)? Any other tips?
  42. B

    Wiki Billing for Implants

    Can the surgeon submit claims for the implants used? If the surgeon supplies the implants and they are not purchased by the ASC, couldn't he submit claims for them? :rolleyes:
  43. D

    Wiki Mitomycin in the ASC

    Can mitomycin be billed separately in the ASC as a supply? Thanks.
  44. D

    Wiki cpt 64520 & 64640

    Is it correct to code cpt 64520 or 64640 twice on the same date of service for Medicare pts and for third party payors (mainly workers comp)? I have a doctor who says yes if he injected twice, it needs to be coded and billed twice. I recently went to a company sponsored seminar that said no...
  45. M

    Wiki Asc billing help~~

    I have to bill for facility or ASC with this scenario... The patient has bleeding fro the splenic flexure and underwent transcatheter coil embolization of a third order branch middle colic artery and suerior mesenteric angiogram... This is ALL I'v got!~ any suggestions would be...
  46. D

    Wiki ASC additional recovery "step down"

    Does anyone charge/code for additional time spent in ASC for recovery observation of the patient if it is needed longer than the standard recovery for each procedure? Example: if the patient needs additional time for anesthesia recovery with minimul nursing assistance, how do you handle?
  47. J

    Wiki Post procedural admit

    I don't code a lot of surgery stuff so my apologies if this is really simple. Patient has a procedure in the ASC at a medical facility. Patient then has to be admitted for post op pain control to the hospital as an inpatient. (2 different facilities). will the admit be billed and paid? Or is...
  48. G

    Wiki Colonoscopy ?screening

    My question is regarding diagnotic coding for a colononscopy in an ASC. Example: Patient came in for a screening but physician found a polyp which was removed. Would you code screening V76.51 as 1st diagnosis or the polyp 211.3?
  49. K

    Wiki CRNA in ASC Billing

    I am billing for a CRNA who is providing propofol sedation for endoscopy patients in an ASC and I need coding help for Medicare. I billed first with the 00740 or 00810 and the QZ and the P (physical status modifier). Medicare denied for "wrong or missing modifier." I billed again with the...
  50. T

    Wiki ASC Coding 101

    We are opening an ASC in a couple of weeks and I have been asked to tackle the facilty coding temporarily until off and running. This is new to me as I have only coded for professinal services. Does anyone have any advice, information, cheatsheets etc..... Anything is greatly appreciated. Tracy