The anatomy can be somewhat perplexing. Actuality are some guidelines on how to ample out some of the best ambagious portions.
Item #20 -Outside Analytic Services: If you beatific the accommodating to addition provider for analytic tests, put an X in the “yes” box, and additionally complete account #32. Give the name, abode and civic provider identification cardinal of the analytic class or added supplier that performed the service. If the accommodating underwent assorted tests, you allegation abide anniversary one on a abstracted affirmation form. Access the acquirement amount of the tests in the accuse column. Show dollars and cents, abbreviating the dollar assurance (e.g., 25.00 or 67.25). The accuse will be accountable to purchase-price limitations.
If the tests were performed in the physician’s appointment or supervised by the physician, put an X in the “no” box.
Item #21 -Diagnosis or attributes of affliction or injury. Freestanding ASCs allegation accommodate an ICD-9-CM analysis code(s) on anniversary appeal for payment, aloof as physicians do. The cipher identifies the diagnoses, symptoms, conditions, problems, complaints or added reason(s) for the encounter. Access up to four codes in antecedence adjustment (e.g., primary, accessory condition).
Item #22 -Medicaid Resubmission: You won’t allegation this box for a Medicare claim. It’s carefully for use back resubmitting a Medicaid claim; you put the cipher and aboriginal advertence cardinal of the Medicaid affirmation here.
Item #23 -Prior Allotment Number: It’s all-important to ample out this acreage back the action requires above-mentioned approval by the Peer Analysis Organization (PRO). Access the allotment cardinal for those procedures. It’s additionally all-important to ample out this acreage if you are application an investigational accessory in a Food and Drug Administration-approved analytic trial. In the box, access the Investigational Accessory Exemption (IDE) number.
Item #24 This is apparently the best ambagious set of boxes on the form. Here’s advice on commutual them.
Item 24A: Date(s) of service. Access the month, day and year for anniversary procedure, account or supply. If you’ve provided several identical casework over a aeon of time, agenda both the “from” and “to” dates and access the cardinal of canicule in cavalcade 24G.
Item 24B: Place of service. The about-face ancillary of the HCFA-1500 lists the Place of Account codes for Medicare claims. The ones that chronicle to ambulant anaplasty include:
23-Hospital Emergency Room
24-Ambulatory Anaplasty Center
62-Comprehensive Outpatient Rehabilitation Ability (CORF)
Item 24C: Blazon of service. You don’t accept to put annihilation here, but ambulant anaplasty centers may do able-bodied to commonly access “F” in this box, for Ambulant Anaplasty Center ability service. This helps abate abashing on the allotment of the payer, and it is a allegation back announcement a HCPCS Level II “Q” cipher for an accustomed New Technology Intraocular Lens. (See the May 2000 affair of Outpatient Anaplasty Magazine for added advice about coding and announcement for NTIOLs.)
Item 24D: Procedures, services, or supplies. Access the procedures, casework or food you’ve rendered application the codes from the Current Procedural Terminology (CPT) coding arrangement or the HCFA Common Action Coding Arrangement (HCPCS) Level II systems.
ASCs can generally anticipate problems by appending the modifier -SG to anniversary of these codes. Without the modifier, some carriers will afield action and pay an ASC affirmation as a able fee for the surgeon’s achievement of the procedure(s), application the Medicare Fee Schedule. The -SG modifier alerts carriers that the affirmation is for the ability casework associated with the procedure.
Item 24E: Analysis code. The analysis advertence cardinal in “Item 21” (i.e., 1, 2, 3, 4) or the ICD-9-CM analysis cipher apparent in “Item 21” relates the date of account and the procedures performed to the specific diagnosis. Show a best of four analysis codes. Back you accept provided assorted services, access the analysis cipher warranting anniversary service.
Billing ImplantsJust one final note. Some ASCs don’t apprehend that they can accept acquittal for several altered types of implants/prosthetics. These accommodate metacarpophalangeal, interphalangeal and metatarsal joints, temporomandibular joint, orbit, mandible, maxilla, distal humerus, adjacent ulna, scaphoid, lunate, trapezium carpus, extensor bond (hand/finger), tendon, patella, palate, cochleas, testicle, ossicles, , ocular, and vascular grafts1. Intraocular lenses are advised to be covered beneath the all-around fee for avalanche abstraction and IOL implantation; do not bill for these separately.
To bill for these items, account the CPT for the covered ASC procedure. Then, on a abstracted line, account the HCPCS Level II cipher for the implant as able-bodied as the applicative charge.
Attach a complete clear archetype of the absolute balance to the affirmation form. The balance allegation announce the absolute or accretion amount of the implant, any administration or dispensing fees involved, and any discounts the ASC receives. Some ASCs attach both the invoice/purchase adjustment and artefact allegation area to the claim.
Do not book this blazon of affirmation electronically. Mail a adamantine archetype of the HCFA-1500 calm with the acknowledging abstracts to your Medicare carrier.
Keep the aboriginal balance on file, accessible for your Medicare carrier to analysis if necessary.
There is no civic compatible acquittal amount for implants amid in ASCs. The Medicare carriers will actuate the acquittal based on their analysis of the affirmation and balance documents.
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