decisionhealth Newsletters, Coder Pink Sheets - 2012 Issue 6 (June)
In ASC, physician gets paid for fluoroscopic guidance but facility doesn’t
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Article Overview
This premium article addresses billing in an ambulatory surgery center setting when a physician performs fluoroscopic guidance during a procedure. It is aimed at coding professionals, physicians, and facility billing staff who need to understand how payment may differ between the professional and ASC facility claims, along with the general role of documentation and payer-specific contracts.
Why This Topic Matters
Claims for procedures performed in an ASC can be split between professional and facility billing, so understanding which component may be separately payable helps avoid denied or inappropriate claims. The article also clarifies the relevance of coding edits and supporting documentation in this setting.
What You Will Learn
- How ASC billing can differ between physician and facility claims
- Why payer or carrier contracts can affect ASC reimbursement
- The role of documentation when fluoroscopic guidance is performed
- How coding edit concepts relate to bundled services in a general sense
Who Should Read This
- Medical coders
- Billing staff
- Physicians
- ASC administrators
- PM&R practices
Codes Discussed
Modifiers Discussed
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