Anesthesia Coding Alert

Question: If an ASC supplies the drugs used by an anesthesiologist, can it bill for the drugs separately from the code for deep sedation? 

North Dakota Subscriber

Answer: The correct answer depends on the drug because not all drugs are separately payable when supplied by an ASC facility. You need to know the “ASC payment indicator” for the drug’s code to check whether it is reimburseable. 

There are usually three ASC payment indicators associated with drugs. These are:

• K2 – Drugs and biologicals paid separately when provided integral to a surgical procedure on ASC list; payment is based on the OPPS (Outpatient Prospective Payment System) rate (e.g., J9355, J9371, Q0138, J0716)
• K7 – Unclassified drugs and biologicals; payment is contractor-priced (e.g. C9399)
• N1 – Packaged service/item; no separate payment is made (e.g., J0200, J0720, J1590, J7506).