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billing for doctor AND facility

  1. Default billing for doctor AND facility
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    I am billing both for the provider and the ASC side (both have own tax ID). While in Hawaii, at the gastro session, I heard someone say that the doctor side of the bill would have one code for the type of removal (snare, etc) no matter how many polyps were removed that way. But the ASC side could bill for each polyp removed by the same technique? I was directed to GASTRO.ORG website, but I'm having trouble finding guidelines for the ASC. Any suggestions?


  2. #2
    Columbia, MO
    I have never heard this either. The code states polyp(s) which is a mulitple code and can be billed only once, I have not heard that the ASC can do something the physician cannot, especially when the procedure codes for the facility must match that submitted by the physician.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Default Website reference
    I just returned from a GI conference and that way of coding was not discussed. We have an ASC and don't bill multiple removals such as you describe. A good ASC billing reference is Check it may help!

    Torilinne, CPC

  4. #4
    polyp removal is coded by the technique and not the polyp. and you can only code one technique no matter how many polyps removed with that technique. If he used a different technique on the same day of surgery you would code the other technique with 59 modifier.

    45380 59

  5. #5
    The Physician coding and the ASC coding should be the same. There is an article on this topic in the Coding Edge magazine of May 2008, page. no # 48.

    Hope this helps.

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