Wiki Anesthesia ASC Facility Charge

[Ortho2018]

Hi, can someone help me with billing Anesthesia Facility Charge for an ASC?
Do you have these charge amounts billed into the fee for the surgery? Or do you bill separately for the Anesthesia?
If you bill separately for the Anesthesia Facility Charge, do you balance bill the patient for the co-insurance amount from the insurance?

Thank you in advance for any help someone can give me on this.

 

[SharonCollachi]

I don't know what you mean by Anesthesia Facility Charge.

There is the anesthesiologist, who usually works for an independent group.
There is the surgeon, who works for a different independent group.
There is the ASC, who bills the facility charges.

 

[Ortho2018]

We are an Orthopedic Surgery Center (separate tax id from the physician's office that owns the ASC)
We have an Anesthesia Company that we work with for our Anesthesiologist(s) (they do their own billing)
Should or could we be billing a Facility charge for Anesthesia done in our facility?

 

[thomas7331]

We are an Orthopedic Surgery Center (separate tax id from the physician's office that owns the ASC)
We have an Anesthesia Company that we work with for our Anesthesiologist(s) (they do their own billing)
Should or could we be billing a Facility charge for Anesthesia done in our facility?

I code for outpatient hospital, which I know is a little different from ASC, but yes, you can and should charge for any anesthesia costs incurred by your facility. The anesthesia company will bill just for the professional services, but the facility can bill for the drugs, supplies, staff time and use of the equipment related to the anesthesia service. Some of your payers may want this charge rolled into the total charge for the procedure itself but, if allowed by the payer, it can be billed as a separate line item under revenue code 370.

Since outpatient surgery facility claims are typically reimbursed at a case rate, the facility charges for anesthesia will likely not have any impact on reimbursement or on patient share for your contracted and/or government payers, in which cases you would not be able to balance bill the patients for this.

 

[Ortho2018]

I code for outpatient hospital, which I know is a little different from ASC, but yes, you can and should charge for any anesthesia costs incurred by your facility. The anesthesia company will bill just for the professional services, but the facility can bill for the drugs, supplies, staff time and use of the equipment related to the anesthesia service. Some of your payers may want this charge rolled into the total charge for the procedure itself but, if allowed by the payer, it can be billed as a separate line item under revenue code 370.

Since outpatient surgery facility claims are typically reimbursed at a case rate, the facility charges for anesthesia will likely not have any impact on reimbursement or on patient share for your contracted and/or government payers, in which cases you would not be able to balance bill the patients for this.

Thank you for your help. Greatly appreciated.
Do you bill all types of anesthesia? Asking because my facility is wanting to bill Nerve Blocks only. I think that is wrong, it has to be all or none, we can't pick and choose!

 

[thomas7331]

Thank you for your help. Greatly appreciated.
Do you bill all types of anesthesia? Asking because my facility is wanting to bill Nerve Blocks only. I think that is wrong, it has to be all or none, we can't pick and choose!

Ah, nerve blocks - that's a whole separate conversation actually - coding for a nerve block is not the same thing as charging for anesthesia, because the nerve block is coded as an additional surgical procedure, and not just as a charge for the anesthesia costs. Facility fees for nerve blocks has been a rather complicated and controversial topic in the facilities where I've coded, and I'm not sure I can give you a definitive answer on this.

Under NCCI rules (see Chapter 2 of the NCCI Policy Manual) a nerve block can be reported separately by anesthesia 'when the surgeon requests assistance with postoperative pain management', and when the mode of anesthesia is general, but is not separately reportable if the mode of anesthesia itself is the nerve block. In other words, since the nerve block code will bundle with almost any surgical procedure, in order to unbundle it with a modifier 59 or XP or XU, it must meet the criteria laid out in the NCCI guidelines. This guidance is a bit confusing from a facility perspective, and I think some facilities have elected not to bill the nerve block codes because the physician documentation often does not adequately reflect that this is a separately identifiable procedure from the surgery and the anesthesia itself.

However, my experience on the hospital side has been that under the current OPPS reimbursement, even when the nerve block is reported, it does not change the reimbursement because the nerve blocks are considered a packaged service and it does not result in a separate line-item payment. My advice would be that if you are going to consider coding for nerve blocks and using the unbundling modifiers, which could potentially result in additional payment for some payers and in some situations, you look over that section of the NCCI manual carefully and make sure that the documentation meets these requirements and supports reporting the block separately.

 

[Ortho2018]

Ah, nerve blocks - that's a whole separate conversation actually - coding for a nerve block is not the same thing as charging for anesthesia, because the nerve block is coded as an additional procedure, and not just as a charge for the anesthesia costs. Facility fees for nerve blocks has been a rather complicated and controversial topic in the facilities where I've coded, and I'm not sure I can give you a definitive answer on this.

Under NCCI rules (see Chapter 2 of the NCCI Policy Manual) a nerve block can be reported separately by anesthesia 'when the surgeon requests assistance with postoperative pain management', and when the mode of anesthesia is general, but is not separately reportable if the mode of anesthesia itself is the nerve block. In other words, since the nerve block code will bundle with almost any surgical procedure, in order to unbundle it with a modifier 59 or XP or XU, it must meet the criteria laid out in the NCCI guidelines. This guidance is a bit confusing from a facility perspective, and I think some facilities have elected not to bill the nerve block codes because the physician documentation often does not adequately reflect that this is a separately identifiable procedure from the surgery and the anesthesia itself.

However, my experience on the hospital side has been that under the current OPPS reimbursement, even when the nerve block is reported, it does not change the reimbursement because the nerve blocks are considered a packaged service and it does not result in a separate line-item payment. My advice would be that if you are going to consider coding for nerve blocks and using the unbundling modifiers, which could potentially result in additional payment for some payers and in some situations, you look over that section of the NCCI manual carefully and make sure that the documentation justifies this.

Thank you so much for all your help and guidance. Appreciate the help!