Wiki ASC Billers Please Help!!

[sctaylor]

I am new to ASC billing. My only experience is outpatient/inpatient professional services. We have a provider who owns an ASC. He wants to bill for his professional services as well as his facility charges. His suggestion is to bill with two claims. For example:
14040 with POS 11 for his professional service and another claim with 14040 with POS 24 for his facility fee. This doesn't seem correct to me.

Would you please shed some light as to how ASC billing works?

 

[capricew]

The POS is reported as "where the procedure/service took place".
I too work for a physician in his clinic, and he owns a certified surgery center that is attached to our building.

Our surgery claims go out 64483 POS 24 on claim form UB-04
Our physician claims go out 64483 POS 24 on claim form HCFA-1500

The service was provided in POS 24 - you cannot bill POS 11 on the physician claim because this will initiate an improper payment.
When you bill a surgery code on a physician claim with POS 11, you are telling your payer that the surgery was performed in your office which will mean a higher payment than your normal contracted rate called a site of service differential. Essentially, you are telling the payer that the physician did the surgery in his office and that no other claims will be filed by a surgery center or an anesthesiologist. This is why your payment is higher because you saved the insurance company money by not sending the patient to an ASC.

Good Luck!
Caprice Walder, CPC

 

[mrsjehu]

ASC Billing

The provider is correct.

You will bill out one for the physician charge with the procedure codes. You use the ASC place of service but with physician charges.
The Facility would be billed separately with SG modifiers and a place of service 24 for ASC. You use the same procedure codes for both. You charges however would be different.

 

[capricew]

The provider is correct.

You will bill out one for the physician charge with the procedure codes. You use the ASC place of service but with physician charges.
The Facility would be billed separately with SG modifiers and a place of service 24 for ASC. You use the same procedure codes for both. You charges however would be different.

I really do not mean to sound disrespectful, but, how is the provider correct?

The provider wants to bill two different POS codes on each claim. That is not correct.

Yes- two claims get sent - one for physician on HCFA-1500 with POS 24
and one for the facility on UB-04 with POS 24 (each claim will have same cpt codes but different charges)
and for most insurances, Modifier SG is no longer required because of the two different billing forms (HCFA-1500 for physician, UB-04 for facility)

The only thing the provider is correct about is that two different claims need to be sent.

Respectfully,
Caprice Walder, CPC