# HELP! Synera Patch ASC vs Physician



## jjayne (Sep 20, 2011)

Does anyone have any experience on billing the Synera Patch?? I started to work for a small company that owns an ASC and in the same build (different suite) run there clinic(so we bill all of their charges). They started applying the patch last April, this is a topical patch that our ASC puts on the pt before pain management injections. 
We have been billing the J3490 until July 1st  2011 when they came out with C9285. We had been billing the charge out threw the physician  portion of the bill because when our ASC was set up they chose to bundle bill on a cms 1500 instead of itemize on a ub04. 
So first question is this ok to bill threw the physician rather than the ASC since it's a patch they put on in the ASC 30 mins prior to the procedure?? 

When we billed Medicare threw the physician Medicare denied  as missing/incomplete/invalid place of service.  When we billed the J code to Medicare threw the ASC they denied it as service/procedure/report cannot be billed separately.  So they started having patients sign an abn form and pay for the patch but still billed medicare the charge threw the physician. When the new C9285 code came out we billed it threw the ASC on a 1500 and they paid it! 
My next question is should the J code prior to July 1st 2011 have been billed threw the ASC and still have them sign a ABN and have the pt pay or would this patch not be chargeable to patients???

Sorry this is probably super confusing but I'm afraid this has been billed wrong and if they got audited I wouldn't want to have any issues. Any help at all would be GREATLY appreciated!!


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