New to ASC

I'm new to ASC and just want to make sure I have this correct....when a prosth implant is used it is included in the procedure performed.

Are there any situations where you would code separately for this?


Hi Tina! I bill for an ASC and the Surgeon, and on the ASC claim we bill out L8699 for the prosthetic implant items. We attach the manufacturer invoice for the item to the claim. We have a "carve-out" on our ASC contracts for several of our biggest insurance carriers and they reimburse us for those implants. If we don't have a "carve-out" with a carrier then yes, they bundle the cost of the implant in with the reimbursement of the procedure itself. MVA insurances and workers comp may pay for the cost of the implant too, without a special contract carve-out. I wouldn't want to bill out a claim without the L8699 just in case it does get reimbursed...but if there is already a history at your ASC of them not getting paid then it's up to you (or your manager) whether to leave it off or not.