Wiki Procedure Room


Laramie, WY
Best answers
Hi, I'm looking for some help on coding for small procedures done in the procedure room.
Our physicians will sometimes do small procedures that do not require going to the ASC. I would like to know the appropriate way to bill out for these procedures. Is the SU modifier appropriate and do we bill the physician charge along with a separate charge for the procedure room?
Any help/advice would be greatly appreciated!

Sally Cookman, CPC, COSC
It does't look like it. Seems most payers follow CMS

Primera Blue Cross
The Plan does not allow reimbursement for services appended with Modifier SU. Useof an office facility and equipment are included in the practice expense of the relativevalue units for a service(s) or procedure(s) performed in the office setting.

Oxford health Plan -

The Centers for Medicare and Medicaid Services (CMS) indicates that the Health Care Common Procedure CodingSystem (HCPCS) modifier SU, Procedure performed in physician's office (to denote use of facility and equipment), isnot payable. CMS establishes Relative Value Units (RVU) for CPT and HCPCS codes that include the costs of runningan office (such as rent, equipment, supplies and non-physician staff costs) which are referred to as the practiceexpense RVU. In accordance with CMS, Oxford does not allow reimbursement for services appended with modifier SUin an office place of service, since the use of the office facility and equipment is included in the practice expense RVU,or the costs associated with operating an office.