Tips To Make Your Asc Coding A Snap

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Is Modifier SG required for all ambulatory surgical center (ASC) claims?
Well, the answer is false for claims with dates of service post January 1, 2008; and if you got that one right, you are on your way to ASC reimbursement success.
Soon, CMS will issue its new quarterly update to the ASC Payment System, which includes HCPCS codes, modifiers, drugs and supplies that are payable for ASCs with effect from April 1.
There are so many changes affecting ASCs every year. But irrespective of all the changes, some aspects of ASC reimbursement have stayed the same. Here's the lowdown on how the ASC rules affect you:
Know where to find ASC-allowed services. CMS maintains a very specific list of codes payable for ASCs; however if you do not know how to access the list, you could be groping in the dark as far as the reimbursements are concerned.
Remember the ‘same-day global' rule. Every procedure the ASC bills has a ‘same day' global period. This makes sense as the ASC is not reporting physician work services – only facility fees. This applies to the medical coder working for ...
... the ASC; however not the doctor who carried out the service.
You can give modifier SG a miss. Previously, when the ASC coder billed Medicare for any service performed in the ASC, he had to list modifier SG as the first modifier on the claim. But then all that changed with the issuance of CMS Transmittal 1410, which read, “Effective for services on or post January 1, 2008, the SG modifier is no longer valid for Medicare services.
For dates of service before January 1, 2008, ASC coders were required to list the SG modifier first on the claim – minus it, the claim would reject immediately.
Discounted surgery modifiers may differ. ASC coders may sometimes use modifier 52 (reduced services), however won't use modifier 53 (discontinued procedure). In its place, insurers normally require ASC coders to call on modifiers 73 or 74 as proper.
Stay in touch with the surgeon's coder. One mistake that can kill your reimbursement is when the physician and the ASC report different codes for the same procedure. As the physician and ASC should report the same codes for each surgery, any coding inconsistency should be ironed out before the claim is submitted.
For more on this and for other specialty-specific articles to assist your ASC coding, stay tuned to a good medical coding resource like Coding Institute.