As an Ambulatory Surgical Centers' medical billers and coders, inquisitiveness is something that is related to your job. Despite the fact that ASC coding has numerous similarities to insurer and hospital coding, it's only a bit different in relation to what you do for a doctor or an office.
In view of Medicare's, ASCs are particular entities operating only to furnish and look after outfit outpatient surgical administrations, which means ASCs can't offer office visits, lab administrations, or like CT and MRI scans. The Medicare Place of Service Code-set characterizes ASCs concisely as an "A detached office, other than a doctor's office, where surgical and diagnostic administrations are provided on an ambulatory." (ASCs utilize Place of Service Code 24 on the Medicare assert frame.)
Like the doctor's office, ASCs utilize CPT and HCPCS Level II codes to charge the majority of their procedures. Unalike to inpatient hospital settings, ASCs don't utilize ICD-10-PCS to report procedures.
Medicare pays for ASC benefits under Part B and requires the CMS-1500 claim form. Healing center based ASCs by and large use the UB-04 form for office charges and the CMS-1500 form to report professional charges for the physician's procedures. However, Be that as it may, in case you're reporting services at an ASC, certainly check payer direction to ensure you know which payer directions to follow.
Medicare doesn't allow specialists to perform any random procedures in an ASC. CMS distributes a list of approved ASC procedures. Basically, the dependable guideline is that procedures performed in an ASC can't be emergent or life threatening, similar to a heart transplant or a re-plantation of a disjoined arm. Additionally, CMS disallows ASCs from facilitating procedures involving major blood veins — so unquestionably no CABGs will be performed in your nearby surgery center. Then again, the procedure should likewise be the type that would be unsafe to perform in a doctor's office.
What happens if your provider needs to cancel a surgery that needs to be done in an ASC? The purpose for terminating the procedure would be some extenuating circumstance threatening the physical well-being of the patient, such as sudden changes in the patient's blood pressure, unexpected chest pain, or some other circumstance that the provider believes puts the patient's life at risk. You need two CPT modifiers specific to ASCs for reporting these situations.
• Modifier 73, Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure Prior to the Administration of Anesthesia
You'll utilize this modifier to tell the payer that the supplier terminated the surgical procedure— one that required anesthesia to perform, before the anesthesia was reported. The supplier would have terminated the procedure after the patient was prepared for the treatment and taken to the operating room. When you report modifier 73, Medicare contractual workers apply a 50 percent payment reduction to the procedures.
• Modifier 74, Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure After Administration of Anesthesia
You'll apply this modifier to a terminated outpatient procedure discontinued by the provider subsequent to administrating the anesthesia. Again, the procedure would have been terminated by the supplier due to a sudden change in the patient's condition, for example, pulse variations, sudden chest pain, or some other serious condition.
Once anesthesia is directed, the procedure is classified as a surgical procedure, and many insurance providers will reimburse in full for the cancelled procedure with modifier 74 appended.
Thing to remember here is that don't use modifier 73 or 74 for selective cancellation of a service or procedure, as these are only for medical reasons found after surgical preparation. In simple words to be able to report modifier 73 or 74, the patient must be on the operation table, prepped and draped in the usual sterilized fashion with the surgeon ready to act, when something happens to the patient that causes the team to stop the procedure in its tracks.