Practice Management Alert

Question:  One of the ASCs we bill for has a “suite” the providers use for procedures that could be done in the office, but they do not have the space or set up to do it in the office. They will perform the procedure in the “suite” at the surgery center. How do we bill out for this? Should we use POS 24 due to the procedure being done within the walls of the surgery center or POS 11 due to the procedure being done in the suite? 

California Subscriber

Answer: You should use place of service (POS) code 24 (Ambulatory surgical center) for this situation, rather than POS 11 (Office). 

Here’s why: Place of service is part of practice expense component of relative value unit (RVU) which determines the provider’s reimbursement. In non-facility settings such as the office, a provider incurs overhead costs like utilities, equipments, furnishings, supplies, etc. Hence, he is reimbursed at higher RVU. 

In your case, the provider is using a separate area within the walls of the ambulatory surgical center (ASC) and using the ASC’s resources not his own office resources. Therefore, the provider is not eligible for extra reimbursement that is available when he performs procedure in his own office.