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Sinus Endosopy/Facility vs. Office

  1. Default Sinus Endosopy/Facility vs. Office
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    One of my Dr's asked me a question that is outside my specialty. Can someone please help with this question? Much thanks to whoever answers this!!

    Q:What is the facility CPT code when a procedure falling under CPT-31237 is performed in an ASC?

    Second, does the facility code (above) include the cost of devices used for the procedure or are they reimbursed separately?

    If CPT-31237 is performed in an office based setting, is it intended to cover the cost of devices used for the procedure and if not, will the devices be reimbursed separately? If they will not be reimbursed separately and CPT-31237 is not intended to cover the cost of devices, can the cost of the devices used in the procedure be passed along to patients after being denied by the payer?

  2. #2
    Columbia, MO
    Facilities use the same CPT codes for the procedures as do the physicians. What changes is the physician POS on the CMS 1500. Typically most procedure codes include all instrumentation necessary to perform the procedure. An endoscopy includes the reimbursement for the scope, and trays and all other instruments needed. No additional can be billed either to the patient or the payer.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    Thanks for the quick response Debra!
    Last edited by wchristensen; 12-01-2010 at 10:16 AM.

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