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ASC vs Hospital Outpatient differences

  1. #1
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    Columbia, SC
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    Default ASC vs Hospital Outpatient differences
    Medical Coding Books
    How much different are these two when it comes to coding?

  2. Default ASC Vs HOPD ASC
    Quote Originally Posted by njwanucha View Post
    How much different are these two when it comes to coding?
    They are quite different. HOPD ASCs are coded based on HOPD regulations. The ASC published rates are applicable at free standing (POS 24) ASCs, not HOPDs. This is why you see so many free standing ASCs consider conversion to HOPDs. Not only is there a difference in the surgical procedures allowed at the facility, there is a significant difference in reimbursement and in what procedures (specifically ancillary procedures) are allowed to be billed.

    Melanie

  3. #3
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    There is a difference in REIMBURSEMENT but there is no difference in coding. There is a difference in which procedures are allowable to be performed in the ASC as opposed to hospital outpatient but no difference in how they are coded. So maily the differences are in the reimbursement department and in the claims submission as in dealing with revenue codes but the coding of the diagnosis and procedures is no different and the usage of the modifiers is no different, this is all based on documentation.

    Debra A. Mitchell, MSPH, CPC-H

  4. Default
    Quote Originally Posted by mitchellde View Post
    There is a difference in REIMBURSEMENT but there is no difference in coding. There is a difference in which procedures are allowable to be performed in the ASC as opposed to hospital outpatient but no difference in how they are coded. So maily the differences are in the reimbursement department and in the claims submission as in dealing with revenue codes but the coding of the diagnosis and procedures is no different and the usage of the modifiers is no different, this is all based on documentation.
    I respectfully disagree. One of the reasons for the difference in reimbursement other than the base rate of the procedures performed is the fact that there are procedures that cannot be reported in a free standing ASC. They are considered as a part of the primary procedure when performed there.

    When the same group of procedures are performed in an HOPD, they are to be reported separately. This is a coding issue and does result in a difference in the coding of an ASC vs. HOPD claim.

  5. #5
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    You are referring to CCI edits which dictates when to bundle and when it cannot be unbundled. Also as I stated some procedures are designated as non ASC allowed procedures. Again this is primarily a reimbursement issue. The procedures are coded based on the documentation. Then the CCI edits will do the rest as far as is a modifier applicable or not but as far as coding rules there is no difference. Outpatients do a different set of CCI edits than do physician office. The modifier rules are the same as well.

    Debra A. Mitchell, MSPH, CPC-H

  6. Default
    Quote Originally Posted by njwanucha View Post
    How much different are these two when it comes to coding?
    Free standing ASCs using physician edits, HOPDs do not, I code for several ASCs that do not have edits as a part of their system and this has to be done manually. It is important for a coder to know what edits to apply for those systems that do not do the work for you.

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