Wiki POS for 64561


Johnson City, TN
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I do hospital coding so I don't normally get involved in the billing for procedures done in the ASC, but I was assigned coding for the InterStim procedures. We are both an office (clinic) and an ASC and have separate NPIs and TAX ids for both. Previously we had 1 tax ID used for both the ASC and professional component. We have a contract with BCBS that allows us to bill endoscopic procedures performed in an ASC as in-office, meaning we bill with the professional NPI and TID with an SG modifier for the 2nd line. I am unable to look at the contract to see if 64561 falls under the same umbrella for us as it is percutaneous and doesn't require moderate sedation. They are wanting me to code it with POS 11 so that the name says the endo center and the professional NPI/TID is on the claim. I am not convinced that this is correct to bill a procedure that was performed in the ASC with the professional NPI/TID even though it is a procedure that can be performed in an office. Advice?