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Physician vs. Facility billing question

  1. Default Physician vs. Facility billing question
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    We are questioning the difference between how codes are reported for the physician and ambulatory surgical center. The surgical center is not billing 29826 when Medicare is the insurance provider because it is not covered for facilities. Is this the correct way for a facility to bill because we will be billing this code for the physician.

    thank you,
    Karen in FL

  2. #2
    Add-on codes fall under Packaged service/item for ASC, they should still be billing for packaged services otherwise it hurts their future reimbursement rates.
    CRC (2018), CPC-P-A (2016), COC-A (2016), CPC-A (2015), PAHM (2010)
    Contract/Fee Specialist - Remote

    20 years health insurance experience: Audit, Claims, Customer Service, Payment Policy, Provider Relations, and Reimbursement

  3. #3
    I agree - 29826 is a covered service and should be reported if it was performed. It is not paid separately to facilities by Medicare because the payment is included in the APC rate for the complete surgery, but that does not mean it is being denied or is not covered. If the surgical center is simply not billing the code because there is no additional payment made for that line item on the claim, then they are coding and billing incorrectly.
    Thomas Field, CPC, CEMC

  4. Default
    Thank you for your responses. This is what I thought and will be bringing the responses to my supervisors attention.


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