Wiki Coding for physician, services performed in ASC

[shecodes]

Physicians are performing surgical procedures in an ASC. We are being told that the physician coding must follow the ASC coding guidelines as far as non-covered ASC services and packed services.

Example of case:
RTC Repair - 29827
Ext Debridement - 29823
SAD - 29826

Per ASC this is considered a packaged service, and ad an add-on, would not be reported for the ASC.

We're being told that due to the ASC packaging, that this wouldn't be reported for the physician and I feel uncomfortable following facility guidelines for professional coding when they cannot provide me with documentation to support their stance.

In reviewing chapter 12 and 14 of the MCR claims processing IOM, I'm repeatedly seeing that physician services are not included in ASC payment and the same methodologies would be used for reporting the physician services in an ASC as they are in an IP facility. Based on that, it is my opinion that the 29826 should be reported for the physician.

Am I misunderstanding? If 29826 is not to be reported, does anyone have any authoritative, official documentation to support this? I'm trying to understand better, but everything I'm finding makes it seem as though this is a missed reimbursement opportunity for the organization I work for and no one is listening.

 

[thomas7331]

You are correct - you should report the physician services the same in an ASC as you would in a hospital. You are being given incorrect information. 'Packaging' is a facility reimbursement methodology - it has nothing to do with coding. Many people seem to confuse packaging and bundling, but they are not the same thing. Packaged codes are not separately paid because they are included in the total payment rate for the claim, but that does not mean that they should not be reported. In any case, you are right - physician claims are not facility claims and are not coded as such - there is no reason you would need to follow facility coding rules, even if they were in fact different from the physician guidelines.