ASC or in Office

Coder.Melisa

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Phoenix, AZ
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New to anything ASC. My Doctor, who does all procedure in his office (POS11), was recently offered to perform his services at an ASC. My doc is Pain management and is also a credentialed anesthesiologist. The ASC has offered to let him performed his services at the ASC after being accredited with the ASC. I am not familiar with ASC and not sure how things would be billed if he were to go to an ASC. Some of the day to day procedures are ESI (62311), Trans (64483), MBB (64493) & Kypho 22514. I know how to bill and what is paid when billed under POS 11 but my question is what are some differences in what is billed for POS 11 versus POS 24 for the ASC. Are there things that are billed out that get paid to the ASC that we might not bill or get paid for in the office? I know that there is a Facility and a Non Facility payments for those codes but what else if anything would be billed & paid? Sorry if this is confusing as I am very confused. :eek:

Thank you for any feed back, it is greatly appreciated. :)
 

KMCFADYEN

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Roanoke, VA
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When provider performs procedures at a facility, the facility supplies and bills for the kits, etc that are used for the procedure.
Most importantly, many procedures will have a decreased reimbursement when done in the facility.
Kyphoplasty is one that really stands out to me.
Medicare allows $7,470.93 when 22513 is performed in the office and only $558.91* if performed in the facility (ASC is considered a facility)
22514 allows $7,461.62 when 22513 is performed in the office and only $520.95* if performed in the facility (ASC is a facility)
*The facility would pay and bill for the Kypho kit.
 

Coder.Melisa

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Phoenix, AZ
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Kelly,
Thank you so much for the feedback, I really appreciate it. Is there a place where I can look up codes for fee schedule for an ASC? Since I bill out for a physician I know how to find the physician fees look up but I was wondering if there is one for ASC fee's? Thank you again:)
 
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