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Get an Overview about Ambulatory Surgical Center Billing  

Since 2008, CMS has annually updated procedures eligible for payment at Ambulatory Surgery Centers, also issuing quarterly updates to covered procedures and services. These updates establish payment indicators and rates for newly introduced Level II HCPCS and Category III CPT Codes related to ambulatory surgical center billing and coding.

Below are commonly utilized CPT codes in Ambulatory Surgical Center billing

For surgical procedures, the 10000 – 69999 range covers a wide pack of services conducted in ASCs. These include, among others:

• Excision of lesions or tumors

• Fracture repairs

• Arthroscopic procedures

• Endoscopic procedures

• Laparoscopic procedures

CPT codes for diagnostic procedures in your ASC practice range within the 70000 – 79999 range. These codes are assigned to:

• Diagnostic endoscopies

• Colonoscopies

• Arthroscopies

• Laparoscopies.

Anesthesia services in your center come within the 00100 – 01999 range. They encompass anesthesia services administered during surgical procedures at the ASC.

CPT codes for ancillary services:

80000 – 89999 range: These codes include different ancillary services such as:

• Pathology and laboratory services

• Radiology services

• Rehabilitation services

CPT codes for supplies and materials fall within the 99000 – 99091 range:

These codes are assigned to document supplies and materials utilized during procedures conducted in your ambulatory surgery center.

Make sure your ASC uses accurate CPT codes to reflect the exact services provided so that you can ensure maximized reimbursements and compliance with stringent coding regulations and guidelines.

You may also use correct modifiers with CPT codes to describe the additional services or procedures rendered in your facility.

You ambulatory surgical center should always check the CMS website as they have a comprehensive list of-

• ASC-covered surgical procedures

• Ancillary services

• The applicable payment indicators

• Exact payment rates for each covered service and procedures before adjustments of regional wage

• Wage-adjusted payment rates

• Wage indices

Modifiers in Ambulatory Surgery Center billing:

There are some modifiers used in your ASC can be same as those used by physicians while others are unique to the ASCs only. Ambulatory surgical center billing services use Modifier 73 Discontinued outpatient hospital/ambulatory surgery center (ASC) procedure prior to the anesthesia is given and surgery preparation has already begun but anesthesia has not been administered.

Once the anesthesia is used and the procedure is terminated, you should use Modifier 74 Discontinued outpatient hospital/ambulatory surgery centers (ASC) procedure. Payment plans can cover 25% to 65% of the allowable amount, contingent upon the modifier and documentation detailing the extent of service rendered.

Read More:

The modifier PT indicates a colorectal cancer screening test that was converted to a diagnostic or therapeutic procedure, signifying that a screening colonoscopy transitioned to another medical service.

So, you might have realized that handling ASC billing is not an easy job as it involves a plethora of guidelines and regulations to navigate. Therefore, outsourcing you billing job could be an ideal solution for you.

Outsource ambulatory surgical center billing services to Sunknowledge:

With nearly twenty years of experience, we are a premier provider of Coding Services for ASC Practices. We specialize in optimizing your medical billing process from start to finish. Our team possesses comprehensive expertise in managing various CPT, ICD-10, and HCPCS codes specific to ASC, including the latest modifiers. Certified coders stay current with the latest ambulatory surgical center billing guidelines and industry changes.

Backed by outstanding references from top ASC clients, we offer extensive support tailored to your needs. Feel free to know more about our comprehensive Revenue Cycle Management services by scheduling a no-obligatory call with us.

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