FEATURE


know the changes occurring each year in coding and billing and make sure that your ASC is receiving the proper reimbursement for all of the procedures.” Lathrop also advocates for educa-


As coders and billers, you want to know the changes occurring each year in coding and billing and make sure that your ASC is receiving the proper reimbursement for all of the procedures.”


—Irina Morrow, Abilene Surgery Center


use for reimbursement. There is just one problem: A lot of the techniques that use these devices are not approved by car- riers, so the procedures are considered experimental. You cannot bill a CPT code for an experimental procedure.” Another common contributor to coding errors is incomplete physi- cian documentation, he says. “Physi- cians are generally aware of coding policies, but some do not follow them.” For example, for procedures involving lesions, closures, flaps and grafts, cod- ing is dependent upon the sizes of these elements. This has always been the case, and yet many operative reports do not include sizes. “Surprisingly, some ASCs will default to using the code associated with the smallest size and take a reduced payment rather than edu- cate the physician on the need to consis- tently note sizes,” Cadorette says. Correct coding requires close atten- tion to detail, Morrow says, which can prove more difficult during busier times.


“I must carefully read operative reports, clinic notes and patient charts to make sure every procedure code and diagno- sis matches the procedure the surgeon performed. I must find the appropriate codes to code out and bill per the opera- tive report and ensure they are all sup- ported in that medical document. This process can be very challenging.” Even a strong grasp of coding rules and guidelines might not be enough to prevent mistakes, Lathrop says. “Often- times, a coding error is really not some- one’s fault. It can be attributable to a lack of a single piece of knowledge. There is a vast array of coding informa- tion and recommendations published by the American Medical Association and other organizations, so it is easy to miss something here and there.”


Keeping Mistakes to a Minimum To reduce the likelihood of errors, Morrow prioritizes education. “As coders


and billers, you want 14 ASC FOCUS FEBRUARY 2020 | ascfocus.org to


tion. “AAPC offers the Certified ASC Coder (CASCC) credential. At TCN, we require all of our ASC specialists to obtain that certification. ASC cod- ing has its own unique set of rules and guidelines that coders for other facility types may not understand.” For resolving coding questions, the internet can be a great friend, Cador- ette says. “For new technology, I always research the device online to see how the procedure that uses it is performed and then compare this to the CPT code pro- vided by the vendor.” He also researches the technology in conjunction with a specific payer and its policies. A few targeted online searches should tell you whether a carrier will typically pay for the technology, he says. To help reduce coding mistakes, Cadorette recommends ASCs per- form or undergo coding audits. “By reviewing a set of claims, you evalu- ate coding performance and hope- fully catch errors sooner rather than later. The recommended number of claims to include in audits and the fre- quency of audits will vary by facility size and desired approach to auditing, but they should be performed regu- larly and preferably by an external source to better ensure objectivity. You will also benefit from another source of expertise.”


When in doubt, Morrow says, seek guidance. “I closely read the opera- tive report so I can understand what was performed and what diagno- sis the patient was being treated for. If


I ever do not understand some- thing, I reach out to the surgeon for him or her to educate me. Accuracy plays a huge role in coding and get- ting paid correctly, so I do not want to risk making an avoidable error.”


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