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With an increase in cases moving to the outpatient setting, it is more important than ever that ASC coders are at the top of their game. ASCs now can perform such complex cases as pacemaker insertion, partial knee replacement and even spinal fusions. Here are 10 ASC quick tips to code by.
1. Colonoscopy — Know the difference between screening and therapeutic colonoscopy cases. Even if a case is scheduled as a screening, after the physician treats a condition, the service is no longer considered a screening. Watch for multiple methods when removing polyps or other lesions during the colonoscopy.
2. Bundling rules — ASC's are subject to the same Correct Coding Initiative (CCI) edits as physicians. If the codes are bundled, the coder must be able to justify why they can be billed together with modifier -59 (distinct procedural service). Examples include a separate body site (such as a different toe), separate diagnosis (such as dislocation vs. arthritis) or a separate lesion.
3. Successful surgery — If a case starts as an endoscopy, but the physician needs to convert to an "open" approach to complete the procedure, only report the appropriate open CPT procedure code. Remember to append a diagnosis from the V64.X range.
4. Know your math — CPT descriptions may list size by centimeter or square centimeter. For example, lesion removal is by cm (including margins), while flap closures are by sq. cm. Keep in mind that closure codes with multiple body sites are added together to determine the largest size. Consider a complex closure of the scalp, arms, and legs: Even if a closure was done in all three areas, they would be added together to determine the right code.
5. CPT descriptions — The code description often will tell the coder the rules. Watch for "(s)" because this denotes the code covers ANY number of levels, injections, insertions, etc. Also, if a code states WITH Fluoroscopy, the C-arm code cannot be reported in addition (for example, when reporting facet injections).
6. Unlisted codes — The coder must choose an unlisted procedure code if no other code exists that describes the services performed.
7. Anatomy — Coders need to be aware of what part of the body the physician is treating. Keeping in mind that there are phalanx of the fingers and the toes, and, the term "cervical" can refer to both spinal anatomy and the female genital system.
8. Spinal surgery — Coders need to review method of approach, levels treated, type of graft and levels of instrumentation when coding spinal fusions. This includes anterior or posterior approach, auto or allograft, structural graft (one piece) or morselized (chips or grindings) graft, as well as additional codes such as bone marrow aspirate or platelet injections.
9. Biopsy vs. Excision — Choose excision CPT codes when the intent of the case was to remove the entire mass/lesion/tumor. Choose a biopsy CPT code when the intent is for pathological study, even if the entire lesion is removed. If a biopsy results in the physician going back and removing the entire mass/lesion/tumor in the same surgical session, report the excision.
10. Diagnosis codes — Coders should report the diagnosis codes that relate to the patient care given at the ASC. If chronic conditions are present, coders should review the record to see if monitoring occurred, including medication given for those conditions. If so, assign the relevant condition as a secondary diagnosis.
Thank you to AAPC for arranging this column.
The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.