Wiki Need Orthopaedic facility help please!

[tammy roach]

Is anyone having a problem billing 23120 and 23130 along with 23412 on the FACILITY billing? We have an insurance requesting payment back for paying these codes in error for the FACILITY. No problem with the physicians charges.
Thanks for any responses. TR

 

[gnhobbs@ppmh.org]

Need Orthopaedic facility help please

I've not had any issues using these codes.
23130 would require a modifier (if documentation supports it) when performed with 23412. (per Optum ASCExpert)

Good luck!

 

[sfaltinson]

23210 - The ASC Payment Indicator for this CPT code is C5 (Inpatient Procedures). This means that the facility service will not be paid since the service was provided in an ASC.

23130 and 23412 both have ASC Payment Indicators of A2 (Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight). This means that the facility service is allowed to bill from an ASC.

If you receive a payback request, I'm wondering if the payer is basing that on code 23210. Maybe their logic is saying that if you did one procedure in an ASC that should have been done as inpatient, they are applying that to the entire surgical encounter, no matter what the ASC Payment Indicator is on the other CPT codes. Just a guess ... query the payer for more info.