Help me understand

mbort

True Blue
Messages
2,338
Location
ENGLEWOOD/DENVER
Best answers
0
An ASC is a facility, therefore you have other things that need to be captured on the facility side that the physicians can not bill for (implants, some drugs/supplies, etc). Not all of the modifiers are applicable for an ASC. Claims, for the most part are billed on UB04's, although there are a few carriers that require a HCFA. I have never coded for a hospital so I do not know what the comparison is in that aspect.

I'm sure I have left something out, but hope this gives you some of the basics :)
 

LORA CRAWFORD

Networker
Messages
44
Location
East Valley, Tempe AZ
Best answers
0
I am in the process of opening an ASC and have never done ASC coding and billing before. It is a bit different but not to much. You use UB-04's for a lot of the carriers, and CMS 1500 for a few (medicare). I will be doing mostly GI and colon/rectal procedures so it's not very different from billing from the provider side. I have been able to go to an ASC locally to see how they operate. It's all the same info, some different formats and rules. If you have a chance to go to an ASC and see how they bill it would be useful to you in your career.
 

smrgr

Guest
Messages
13
Best answers
0
Lora,
I currently bill for an ASC for GI procedures if you need any help!
Sue
 

nosillanaj

Guest
Messages
4
Best answers
0
ASC billing

I have been billing for an ASC for a year and half and we bill all our surgeries on UBs. But we also do Physician billing and they are billed on HCFAs. We don't do Medicare so I'm sure we are very different from places that do.

All the codes we use for both are from the CPT book and are basically the Physician codes I learned in school. We don't use any hospital codes. Since our patients don't actually spend any time in the hospital, we don't need to.

So basically the physician billing and ASC billing is the same as far as code usage goes. As someone else said, the ASC is the facility. So for our ASC billing we have itemized time and materials that go with the claim which is an itemized list of everything used in the surgery from a bandaid to OR time. (gloves, surgical trays, implants, medication, etc.) That is sent with the claim. For the physician billing we just bill a one line item of the surgery. Most of our surgeons bill their own surgeries because they just come here to use the facility. But we do have a few doctors that we "own" :) So we do the billing for those physicians.
 

coderguy1939

Guest
Messages
643
Best answers
0
Also, check your Appendix A modifiers for Ambulatory Surgery Center Use in your CPT manual. It details the differences--no modifier 51 for instance (except for Medicare in California).
 
Top