Gastroenterology Coding Alert

Learn whether to place modifier SG first -- or last If you're a gastroenterology coder and dipping your toe into ambulatory surgery center (ASC) coding, then you know that ASCs present unique challenges. You've got questions -- and we've got expert answers to help make certain your claims are picture perfect. 1.  Watch Out for Non-Approved ASC Services Question: I know that Medicare will deny the ASC's charges for any procedures that aren't on the ASC's list of approved services, but what happens if the physician performs a nonapproved service anyway? How can we collect for the ASC's portion? Answer: Occasionally, the physician will perform   a procedure in the ASC that Medicare does not include on its list of approved ASC services. The ASC cannot ask the patient to sign an advance beneficiary notice (ABN) for a service that is not on the approved list,  nor can the ASC bill the Medicare patient for any  unpaid balance, says Annette Grady, CPC, CPC-H, CPC-P, OS, an independent healthcare consultant  and American Academy of Professional Coders professional medical coding curriculum instructor and workshop educator.

When the service is not covered in an ASC, Medicare will make no facility payment, but the physician can still collect for his portion of the surgery. If the physician chooses to perform a service not on the approved ASC listing, the ASC should make arrangements with that physician for reimbursement because Medicare pays the physician the ASC's portion of the payment. Many ASCs use the difference between the hospital facility and the nonfacility reimbursement and then bill that amount to the physician. 

Best practice: If this occurs, you should ask the physician to sign a document stating he understands that the procedure is not on the ASC list and that he will be responsible for reimbursing the ASC the difference between the hospital facility and nonfacility reimbursement, Grady says. 2. Coordinate Joint ASC and Practice Codes Question: When a physician owns both the ASC and practice in the same building and performs a colonoscopy, I have to bill for his services and also for the facility services. We also bill for the anesthesia times and medications. We use a CMS-1500 form for the physician's service and anesthesia and UB92 claim form for the facility, but should I use the same codes for all? Answer: You would use the same codes for both the physician and the ASC, says Margaret Fischer, CCS-P, ACS-GI, business office manager for Tacoma Digestive Disease Center in Wash. This includes both CPT and ICD-9 codes.

Keep in mind: You should remember that almost all GI procedure codes include anesthesia services, and all the ASC facility claims include the cost of medications. "We put modifier SG (ASC [...]