Results 1 to 9 of 9

Help me understand

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

    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!

    Tina Reich, CPC, CPC-I, CEMC

  2. #2
    I have the same question.

  3. #3
    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
    Modesto, CA; Central Valley Chapter
    Thank you, yes it does!
    Tina Reich, CPC, CPC-I, CEMC

  5. #5
    East Valley, Tempe AZ
    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
    I currently bill for an ASC for GI procedures if you need any help!

  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
    East Valley, Tempe AZ
    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
    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).

Similar Threads

  1. Hard to understand
    By decus1956 in forum Interventional Radiology
    Replies: 5
    Last Post: 05-02-2013, 11:03 AM
  2. Does anyone really understand the application of External Cause E-Codes?
    By ollielooya in forum Medical Coding General Discussion
    Replies: 9
    Last Post: 11-07-2012, 01:55 PM
  3. 5010 in terms I can understand!!
    By American_Ginger in forum Behavioral Health
    Replies: 1
    Last Post: 03-20-2012, 05:01 AM
  4. Not sure I understand this correctly
    By Lynda Wetter in forum E/M
    Replies: 2
    Last Post: 01-20-2012, 09:36 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.