Understanding ASC billing and coding

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Beginning January 1, 2008, the CMS publishes updates to the list of procedures for which an ASC may be paid each year. In addition, CMS publishes quarterly updates to the lists of covered surgical procedures and covered ancillary services to establish payment indicators and payment rates for newly created Level II HCPCS and Category III CPT Codes. Keep reading to learn ASC billing and coding.

The complete lists of ASC-covered surgical procedures and ASC-covered ancillary services, the applicable payment indicators, payment rates for each covered surgical procedure and ancillary service before adjustments for regional wage variations, the wage-adjusted payment rates, and wage indices are accessible on the CMS Web site.

To be paid under this provision, a facility must be certified as meeting the requirements for an ASC and must enter into a written agreement with CMS. ASCs must accept Medicare’s payment as payment in full for services with respect to those services defined as ASC services. The physician and anesthesiologist may bill and be paid for the professional component of the service also.

Certain other services such as lab services or non-implantable DME may be performed when billed using the appropriate certified provider/supplier UPIN/NPI. The understanding basics of ambulatory surgery center billing aren’t hard to master, but they do differ from physician and facility requirements. ASC billing is quite different from either regular physician billing or facility billing. Unlike physician medical billing, which requires adherence to a few highly specialized guidelines in order to get reimbursed, ASC billing and coding aren’t centered on a specific medical specialty.