Wiki Surgical center

[Dorthi]

We have primary care, Urgent care and a GYN (OB not included). Our GYN has started going to the surgery center to do procedures and they are paying pretty low in my opinion. Can someone please advise me on this. BCBS of Florida for a 58565-26 we billed out according to the fcso fee schedule and billed it out at $3503.00 and the AA was only $485.45.

 

[csperoni]

If the place of service is a free-standing, Article 28 surgery center that will be billing the facility portion, I'm not sure why you appended modifier 26. I don't even think -26 for professional component is a valid modifier for surgery.
To me, if the location is a true ASU, bill with POS 24 and 58565 for RVU of 12.25. Physician should get paid same as doing procedure in any other facility (inpatient, outpatient)
If the location is NOT an Article 28 ASU, but rather a surgical suite in the practice (and the physician is supplying his equipment, such as AAAASF and not billing facility), then POS 11.
Based on what you described, I think it's option 1.
Hope this helps.

 

[CodingKing]

The reimbursement is lower if done in a facility since the full practice expense is not incurred by the physician (facility submits separately) The PE RVU component is cut from the total professional RVU since the facility incurs the overhead expenses. PC/TC split does not apply to surgical procedures, the codes get a PC/TC indicator of 0 (The concept of PC/TC does not apply since physician services cannot be split into professional and technical components)

Most of the supplies and equipment used belong to the facility and not the physician. For example the following are the highest cost - direct expenses which are not incurred by the physician but are inured by the facility

- kit, hysteroscopic tubal implant for sterilization
- endoscope, rigid, hysteroscopy
- video system, endoscopy (processor, digital capture, monitor, printer, cart)