I am an ASC coder, CASCC, at a multi-specialty ASC. We had an audit that came back and dinged almost all 35 charts stating I should code anxiety, high cholesterol, nicotine use and other diagnoses listed on the history and physical. I code from the op-note, the coding test I took only gave me the op-notes and anxiety and the other issues weren't options on my test. I have never done that and those conditions are not listed on the op-notes. I have searched and searched for information regarding this but all I can find is that CMS states an ASC is defined as an entity that operates exclusively for furnishing outpatient surgical services to patients. I can not find any guidance from a reputable source that says I shouldn't code those conditions for an outpatient surgery at an ambulatory surgery center but I keep thinking back to my test. We have different coding rules, like we don't bill modifier 50, we bill two line items with RT and LT. Do any of you have any sources where I can find an answer for my rebuttal or any ideas?
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Wiki Audit said ASC should note anxiety, nic use, etc.
- Thread starter CJBlair2
- Start date
1formissy
Guru
I would ask the auditor why they are requesting to code diagnosis that are from the H&P rather than the body of the operative report. We should not be coding diagnosis that are not either directly related to the procedure performed, nor anything we are treating during that encounter.
Far as billing modifier 50, or not billing, be careful because many payers want bilateral services to be billed on 1 line with a modifier 50 rather than 2 lines with the RT,LT. Even if the 51 is appended to the second line. There are also MUE edits and they could bounce off any codes that are bilateral and have a MUE of 1 but billed on two lines.
Far as billing modifier 50, or not billing, be careful because many payers want bilateral services to be billed on 1 line with a modifier 50 rather than 2 lines with the RT,LT. Even if the 51 is appended to the second line. There are also MUE edits and they could bounce off any codes that are bilateral and have a MUE of 1 but billed on two lines.