Wiki Facility location

[Blackhorse]

One of our pain management facility is one of the rooms inside a big room. There are 2 rooms in this huge room. One room is for MD to do office visit, the other room is used as ASC for injections.

After the translaminar ESI, PT received a bill for facility deductible and professional deductible which makes him angary. He says the injection was done in the doctor's office, he should not pay for the facility deductible.

I don't know how to explain to him that one of the rooms is considered ASC facility.

 

[csperoni]

I don't know about CA rules, but in NY, you can't have a location where 1 room is an ASC and 1 room is an office.
In fact, in my practice we previously had a AAAASF surgical suite (with an anesthesiologist, recovery room, etc.) and even that does not qualify to bill as facility ASC. It was considered office based surgery, not facility based surgery.
I suppose my first question would be to confirm it is actually an ASC. Here's a good AAPC article explaining some of the guidelines of an ASC https://www.aapc.com/blog/24327-asc-coding-and-billing-know-whats-important/.

If your location is an ASC, why is the patient not being informed that they are getting a facility procedure prior? Usually the patient is signing some type of informed consent, facility forms, etc. If your billing is definitely compliant, I would explain to the patient that the procedure received cannot safely be done in a standard office space, and where he had the procedure is considered a facility.

 

[Blackhorse]

I don't know about CA rules, but in NY, you can't have a location where 1 room is an ASC and 1 room is an office.
In fact, in my practice we previously had a AAAASF surgical suite (with an anesthesiologist, recovery room, etc.) and even that does not qualify to bill as facility ASC. It was considered office based surgery, not facility based surgery.
I suppose my first question would be to confirm it is actually an ASC. Here's a good AAPC article explaining some of the guidelines of an ASC https://www.aapc.com/blog/24327-asc-coding-and-billing-know-whats-important/.

If your location is an ASC, why is the patient not being informed that they are getting a facility procedure prior? Usually the patient is signing some type of informed consent, facility forms, etc. If your billing is definitely compliant, I would explain to the patient that the procedure received cannot safely be done in a standard office space, and where he had the procedure is considered a facility.

Thank you so much for your info. I really appreciate it