Medical coding for Ambulatory Surgical Centers is a field that varies greatly from standard medical coding for hospitals and surgeons. ASC’s have a different set of regulations they need to follow. Some ASC’s may be inaccurately using the same codes that surgeon’s use, which may attract auditors and decrease reimbursement. When it comes to medical coding, ASC’s walk a fine line. Some procedures require ASC’s to follow the rules for physicians, while others require them to follow hospital rules, and some medical codes are unique to ASC’s.
Because ASC medical coding is more complex than typical medical coding, well-trained ASC medical coders are hard to come by. Few ASC medical coders are certified, and even less have previous experience. Outsourcing medical coding is typically the most effective method ASC’s use. At Aviacode we have highly trained ASC certified medical coders. We also have a team of Quality Assurance Coders to make sure everything has been coded accurately.
Coding For Medicare
While an ASC is typically labeled as a facility service, Medicare requires ASC’s to send their bills to the professional fee payers while using a facility fee claim form.
Coding for Medicare patients requires medical coders to follow a list of approved procedures for ASC’s. Medicare publishes this list of covered procedures each year and typically revises it every quarter. This list is based on the following criteria:
- They are not life threatening
- They cannot be executed safely in a physicians office
- They can be optional
- They can be urgent
It’s also important for your ASC to be aware that Medicare will not reimburse you for patients being treated in your center that also reside in a skilled nursing facility.
The Medical Coding Hierarchy
Your Medical Codes should be ordered starting from the highest possible reimbursement to the lowest possible reimbursement. ASC’s insurance reimbursement will be decreased if medical codes are not placed in that order. For example Medicare might decrease the amount of a procedure that is listed second by 50%. So if you have one procedure listed as $2000 and another listed as $1500, list the $1500 procedure second in order to get a higher return.
Understanding Your Managed Care Contracts
If an your ASC decides to have a medical coder in house, Make sure that they have access to refer to your managed care contracts. It is essential that they understand: the time frame allotted to submit a claim, how long they have to review an adjudicated claim, how to appeal a claim, and what the payment policy is.