Wiki Office Based Surgery Billing/Reimbursement

[KristinM522]

Hello All!

Does anyone have any information on office based surgery billing/actually have a surgical suite in your office? We are researching the possibility of opening a suite in office for our pain management/spine doctors to perform level II surgeries. I have a few questions:
Do you still bill as POS 11?
Are you reimbursed the facility fee?
What kind of procedures do you do in the suite other than ESI's, RFA's etc..?

I do not have any experience on the billing/reimbursement side of things, I mainly do surgical coding (front end only, code it out and never see it again) but my administrator has given me this task to research and I do not know where to start. I have found information regarding becoming accredited which I have passed on. I think if she chooses an organization to do that with we could get a lot of the questions answered by them.

Thank you in advance for any help/advice you can offer!

 

[dchenkin]

First I would gain an understanding of your state's health codes regarding the formation of an OBS facility in your office, as those codes will specify which accrediting agencies the state accepts. Second, what is your clientele or expected clientele? For example, in NYS Medicaid and Workers Comp will not pay a separate OBS fee. Currently, no-fault carriers do not have to pay OBS facilities but that has been challenged in court and will be argued before the Court of Appeals (the highest state court) this week. Is there an applicable fee schedule? Check with your private insurance carriers whether they pay or not. I am not sure how Medicare views payment of OBS facility fees but I would check the LCDs in your area.

Just a couple of thoughts off the top of my head.

 

[efilandalex]

NYS OBS Fee Billing

In the state of NY does anyone know if OBS facility fees should be billed on 1500 or UB04. This is a true OBS billing POS 11, not an article 28 facility. Currently we are billing commercial payers only.

Thanks for your help.

Jenn

 

[TGIF2022]

Yes, we do many skin tag removals, biopsies, mole removals, colposcopies, even circumcisions and the pos is 11. We bill commercial and medicare plans.