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Help me understand

  1. #1
    Location
    Modesto, CA; Central Valley Chapter
    Posts
    225
    Default Help me understand
    Medical Coding Books
    HI,

    Can someone take the time to explain some of the differences between coding/billing for ASCs and physicians?

    If so I would greatly appreciate it!

    Thanks
    Tina Reich, CPC, CPC-I, CEMC

  2. #2
    Lightbulb
    I have the same question.

  3. #3
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    An ASC is a facility, therefore you have other things that need to be captured on the facility side that the physicians can not bill for (implants, some drugs/supplies, etc). Not all of the modifiers are applicable for an ASC. Claims, for the most part are billed on UB04's, although there are a few carriers that require a HCFA. I have never coded for a hospital so I do not know what the comparison is in that aspect.

    I'm sure I have left something out, but hope this gives you some of the basics

  4. #4
    Location
    Modesto, CA; Central Valley Chapter
    Posts
    225
    Default
    Thank you, yes it does!
    Tina Reich, CPC, CPC-I, CEMC

  5. #5
    Location
    East Valley, Tempe AZ
    Posts
    44
    Default
    I am in the process of opening an ASC and have never done ASC coding and billing before. It is a bit different but not to much. You use UB-04's for a lot of the carriers, and CMS 1500 for a few (medicare). I will be doing mostly GI and colon/rectal procedures so it's not very different from billing from the provider side. I have been able to go to an ASC locally to see how they operate. It's all the same info, some different formats and rules. If you have a chance to go to an ASC and see how they bill it would be useful to you in your career.

  6. Default
    Lora,
    I currently bill for an ASC for GI procedures if you need any help!
    Sue

  7. Default ASC billing
    I have been billing for an ASC for a year and half and we bill all our surgeries on UBs. But we also do Physician billing and they are billed on HCFAs. We don't do Medicare so I'm sure we are very different from places that do.

    All the codes we use for both are from the CPT book and are basically the Physician codes I learned in school. We don't use any hospital codes. Since our patients don't actually spend any time in the hospital, we don't need to.

    So basically the physician billing and ASC billing is the same as far as code usage goes. As someone else said, the ASC is the facility. So for our ASC billing we have itemized time and materials that go with the claim which is an itemized list of everything used in the surgery from a bandaid to OR time. (gloves, surgical trays, implants, medication, etc.) That is sent with the claim. For the physician billing we just bill a one line item of the surgery. Most of our surgeons bill their own surgeries because they just come here to use the facility. But we do have a few doctors that we "own" So we do the billing for those physicians.

  8. #8
    Location
    East Valley, Tempe AZ
    Posts
    44
    Default
    Thanks Sue, I am just now back on the website and seeing what is new. Who knows I may be contacting you in the future. Lora

  9. #9
    Default
    Also, check your Appendix A modifiers for Ambulatory Surgery Center Use in your CPT manual. It details the differences--no modifier 51 for instance (except for Medicare in California).

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