What Can ASCs Do?


Continue providing quality feedback/ comments, participating in registries and performing benchmarking and quality reporting so ASCA can con- tinue to advocate on behalf of your facility by validating the need for com- parable HOPD rates. Communicate with your physicians. ASCs can easily pull case counts via a variety of reports but what about the cases that never make it to your facil- ity? Be proactive and communicate with your providers about the compari- son tool—the good and the bad. Recruit your physicians’ staff in keeping tabs of the amount of cases they are not bring- ing to your ASC due to the cost dispar- ity (or other) when indicated. Make it easy for them. Develop a grid that can easily be maintained or checked when indicated. Provide the grid to the physi- cian’s office scheduler once the physi- cian is on board with tracking. It is an absolute no-brainer the over-


whelming savings ASCs can provide. With continued advocation, eventual legislation reform and consistent report- ing these obstacles will be overcome.


Cristina Bentin is the president of Coding Compliance Management LLC in Franklin, North Carolina. Write her at cristina@ccmpro.com.


Resources ■


Reducing Medicare Costs by Migrating Volume from HOPD to ASC study by KNG Health Consulting


■


Department of Health & Human Services


Centers for Medicare & Medicaid Services


42 CFR Parts 410, 411, 412, 414, 416, 419, 482, 485, 512


[CMS-1736-FC, 1736-IFC] ■ CMS-1736-FC, 1736-IFC ■ 42 CFR 416.166


■


medicare.gov/procedure-price- lookup/cost/27447


20 ASC FOCUS APRIL 2021 | ascfocus.org


Improve Claim Compliance Use correct modifiers BY STEPHANIE ELLIS, RN


In the coding world, mod- ifiers are two-digit sym- bols added to CPT pro- cedure codes to signify the procedure has been


altered in some way. Medicare and many payers accept modifiers. How- ever, proper use can be confusing since not all payers require modifiers to be used the same way. According to Cur- rent Procedural Terminology (CPT) guidelines, not using required modifi- ers when necessary can cause unnec- essary claim denials. Modifiers that affect reimbursement, for instance -59, are sequenced before those that are informational only, such as -RT. Certain modifiers, such as 76, 77, 78 and 79, are used when a patient returns to the OR for another procedure the same day or close to the time another procedure with a global period was performed. The ASC facility’s normal global period is 24 hours from the time the procedure begins. It is not 10 or 90 days like a physician’s global period. If you receive a denial that sounds like a global period issue, verify that the appro- priate modifier has been appended.


-50 Bilateral Procedure For bilateral procedures, use the -50 or -RT/-LT modifiers when an identi- cal procedure is performed on both the right and left sides of the body. The policies that payers have for the use of modifiers for reporting bilateral proce- dures can vary. Check with each payer for their preferred method of billing bilateral procedures. Do not mix meth- ods or modifier types. Never use the -RT/-LT modifiers on the same code as one line item on a claim. Billing with


one line item can only be done using the -50 modifier. Do not use bilateral modifiers on those CPT codes with verbiage


describing procedures as


“bilateral” or “unilateral or bilateral.” Since Medicare in most states does


not allow use of the -50 modifier for billing bilateral procedures, the fol- lowing methods can be used pending reporting requirements: 1. The best method to use for Medi- care is to bill using the –RT and –LT modifiers: 64493-RT 64493-LT


2. Bill code as one line item, with no modifier and list a “2” in the units field on the claim form. Be sure to double the fee, if this method is used (also not recommended) 64493 2 Units


Common methods for billing bilat-


eral procedures to payers other than Medicare include but are not limited to the following: 1. Bill same code twice with the -50 modifier on the second code (do not use for Medicare) 64493


64493-50


2. Bill code as one line item, with the -50 modifier and be sure to double the fee if this method is used (do not use for Medicare) 64493-50


-51 Multiple Procedures ASCs should not use the –51 modifier on their CPT codes, unless the payer specifically requires its use. This modi- fier is for use on physician claims only when more than one procedure is per-


The advice and opinions expressed in this column are those of the author and do not represent official Ambulatory Surgery Center Association policy or opinion.


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34