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ASC and Supplies and Meds

  1. #1
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    Pottstown/Philadelphia
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    266
    Default ASC and Supplies and Meds
    Medical Coding Books
    I have never coded for ASC before so I have a few questions; when is it appropriate to code for supplies (even if not stated in note such as trays) or stated as nasal cannula? When would you code for meds such as demerol prior to a bronchoscopy? When do you know to code from ICD9 procedure or CPT procedure? Thanks ahead! Any other pointers for ASC would be very helpful.

  2. #2
    Default ASC supplies
    You can probably find your answer by viewing this link, I hope it helps...http://www.cms.gov/center/asc.asp
    NoRaX

  3. Default ASC Coding
    Quote Originally Posted by jifnif View Post
    I have never coded for ASC before so I have a few questions; when is it appropriate to code for supplies (even if not stated in note such as trays) or stated as nasal cannula? When would you code for meds such as demerol prior to a bronchoscopy? When do you know to code from ICD9 procedure or CPT procedure? Thanks ahead! Any other pointers for ASC would be very helpful.
    Ambulatory Surgery Foundation has awesome tools for coding ASC. These are all CMS based rules, so your commercial carriers may allow for other supplies to be billed - it will be laid out in your contract- but for a good baseline tool, you can't beat this Plus it's free1

    The link here will take you to the page with Medicare rate calculator (you can put in your zip code so it's location specific), a device intensive list (most implants in an ASC are included in the payment for the procedure), a list of ancillary procedures and supplies which are payable at an ASC, procedures that are considered as included in another in an ASC and office based procedures which can be performed in an ASC and what the rules are.

    http://ascassociation.org/medicare2011/
    ASC coding and billing is quite different. I would really encourage you to attend whatever ASC association meetings you have in your area. They are a great resource. If you have any quesitons I can help you with in the meantime, just let me know.

  4. #4
    Location
    Pottstown/Philadelphia
    Posts
    266
    Default
    This is great information! Thank you. I went to the first suggestion even before posting and was not having any luck finding any help with what can and can't be billed. Thank you. As for ASC association meetings, how can I find if there is one in my area?

  5. Default
    Quote Originally Posted by jifnif View Post
    This is great information! Thank you. I went to the first suggestion even before posting and was not having any luck finding any help with what can and can't be billed. Thank you. As for ASC association meetings, how can I find if there is one in my area?
    For some reason it seems that CMS website is a great resource for everything but ASCs.

    The PA association doesn't have a meeting until 4th quarter, but I don't think you are too far from the New Jersey Association. Here is a link to their website: http://www.njaasc.org/index.asp

    They have an all day meeting on June 2nd and in my humble opinion are really one of the most politicially active and well-organized associations in the country.

    Melanie

  6. #6
    Default
    Melanie - I found your replies to this older post, as I was looking for the same information.

    Do I understand you to say that some insurance companies will allow all of the separate billing for supplies, equipment, drugs, etc? I thought all ASC procedures were billed as a group; regardless if it's Medicare or not?

    If so, does that mean that we should code/bill a private insurance for all of the separate charges?

    Thank you for your input!
    Lora

  7. Default ASC Supplies & Meds
    Hi,

    CMS required that implants, supplies and medications be submitted by hospitals on their claims. In fact, a claim may be totally rejected if a required device code does not accompany the procedure. They use this information to gather cost information to set the weights of procedures for the next year (they need the total cost, even though they do not reimburse each item). After the procedure is weighted in the outpatient setting (to include all costs associated with the procedure), this is used to formulate the reimbursement amount for ASCs. CMS specifically states that ASCs should not include these additional codes on their claims, as the costs are determined by the hospital data.

    I hope this is helpful to you.

  8. Default implants/supplies in ASC
    Quote Originally Posted by Lassal423 View Post
    Melanie - I found your replies to this older post, as I was looking for the same information.

    Do I understand you to say that some insurance companies will allow all of the separate billing for supplies, equipment, drugs, etc? I thought all ASC procedures were billed as a group; regardless if it's Medicare or not?

    If so, does that mean that we should code/bill a private insurance for all of the separate charges?

    Thank you for your input!
    Lora
    While it's true CMS has designaed device intensive procedures for which they include the cost of the device in the payment for the procedure code (meaning the implant itself is not billed separately), that is not the case with commercial payers.
    You would still bill those to a commercial payer unless your contract states that the device is included in the reimbursement of the procedure itself.
    If not. you should not use CMS implant billing guidelines for commercial or workers compensation.

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