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Billing, coding issues for outpatient surgery
If you don't bill and code correctly, you could be leaving money on the table, in addition to being noncompliant, warns Stephanie Ellis, RN, CPC, president, Ellis Medical Consulting in Brentwood, TN. Ellis spoke at a recent coding seminar held by the Ambulatory Surgery Center Association.
Focus on these particular areas, Ellis advises:
Transforaminal injections are a target area of the Office of Inspector General due to their increased billings to Medicare, Ellis says. "Medical necessity must be proven to give these injections," she says. "Be sure that for patients receiving multiple transforaminal injections over time, there is documentation of improvement from these injections in the medical record."
Billing noncovered CPT codes for ASC services with CPT codes for covered services.
Some providers use billing codes that don't properly describe the procedure performed, Ellis says.
Billing for new procedures that do not have existing CPT codes with codes for procedures that do not fit.
"Carefully check out advice on coding for new technology or equipment you get from salespeople and equipment reps," Ellis warns. "If they give you flawed advice and you code incorrectly, you are still responsible."
Place of service errors on claim forms.
Remind physicians using your facility to use POS 24 as the place of service on their claims for procedures performed at the ASC facility, rather than POS 11 for their office, Ellis advises, "If surgical procedures are performed at their office, they are reimbursed at a higher rate than when they are performed at the ASC, which can be a fraud issue," she says.