Wiki ASC Discontinued Procedure

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k8mbee

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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 with patient was 45 minutes, and it all took place in the pre-procedure bay area of the ASC. There was some talk of billing with modifier 52, but not sure if this is completely accurate and if so, which claim would that go on (prof or facility)?
 
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k8mbee said:
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 with patient was 45 minutes, and it all took place in the pre-procedure bay area of the ASC. There was some talk of billing with modifier 52, but not sure if this is completely accurate and if so, which claim would that go on (prof or facility)?
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check mod "73" for ASC and "53" for physician.
Also read note under mod "73": the elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be report.
 
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such78 said:
check mod "73" for ASC and "53" for physician.
Also read note under mod "73": the elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be report.
Click to expand...
I was initially thinking of 52 for professional and/or 73 for ASC facility claim, but everything I have researched shows that 73 is only to be used when anesthesia would have been used during the procedure- I will add that a lot of the more in depth "guides" I have found are unclear or outdated so that may not be 100% correct. The patient was not scheduled for moderate/conscious sedation of any kind. I wouldn't think this situation would be classified as elective cancellation, as it was a medical decision by MD based on the wellbeing of the patient with documentation that substantiates it was a medical decision to discontinue. I just want to make completely sure that we don't fraudulently bill, but also aren't missing out on any possible charges, since they did spend a good portion of time with the patient, and had to discard all the medication that was already drawn/turn the room.
 
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If the procedure was cancelled after anesthesia was admitted, mod 74 will be applied for ASC. Mod 52 is for procedure partially reduced, and your physician did not start the procedure.
I code for facility, when procedure is cancelled because due to some medical issue (high bp, glucose, etc.). I assign dx the reason of surgery and procedure cancelled due to whatever reason to finalize the case.
 
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k8mbee said:
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 with patient was 45 minutes, and it all took place in the pre-procedure bay area of the ASC. There was some talk of billing with modifier 52, but not sure if this is completely accurate and if so, which claim would that go on (prof or faci
Click to expand...

k8mbee said:
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 with patient was 45 minutes, and it all took place in the pre-procedure bay area of the ASC. There was some talk of billing with modifier 52, but not sure if this is completely accurate and if so, which claim would that go on (prof or facility)?
Click to expand...
Hi there, this is completely unrelated! but i just saw your post, and wondered if you could lend me a hand. 😞
I'm new to ASC billing so probably my question would be silly, but I just need to hear it from someone that does this and it seems that you do. Our Center is billing same as you, Professionals for our group of Surgeons AND for the Facility charge since we own it. However they are not adding the TC/26 to either of the claims. I brought it up to the manager and was told that since they are using the 2 different NPI numbers (Physician/Facility) that the MOD is unnecessary? is this how it works? Please help! I'm so confused!
 
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