Wiki Parallel billing for ASC and Surgeon

[LRH]

Should ASCs and surgeons bill for and be paid for the same outpatient surgeries during the same session? Two examples:

1. Surgeon billed for laparoscopy with biopsy (49321). Facility billed for same encounter as unlisted laparoscopy procedure (49329). Can you think of circumstances in which the unlisted procedure should be allowed? (The authorization was for 49321.)

2. Surgeon attempted lap chole (47562); it was unsuccessful, so he then performed an open chole (47610). He was paid only for 47610. Should the ASC be reimbursed for both procedures, or only the more complex one?

Thank you

 

[bethh05]

Sounds like whoever is doing the coding for the ASC should have done some more investigating before reporting the unlisted code. In the case of the attempted Lap cholecystectomy, I was always taught once a procedure becomes an "open" procedure, that is what is coded, not the attempted procedure. Anyone know any different?

 

[montgyspy]

Yes, I agree in regards to investigating more into what was done during the procedure.
As for a procedure that was attempted, I was taught that you would need to code the procedure w/the appropriate modifier & send along the documentation for the billing. You may not get reimbursed the amount owed, but you should get something.

 

[juanitamendoza]

When a laparoscopic procedure is converted to an open procedure you only code and bill the open procedure. Add diagnosis V64.41 laparoscopic surgical procedure converted to open procedure. However, for an ASC, when a procedure is discontinued, then you code and bill the intended procedure with the appropriate modifier (73 or 74). In this case you'd add the appropriate discontinued diagnosis code V64.X. The physician code(s) and facility code(s) should generally match.