Part B Revenue Booster: Time To Brush Up On ASC Coding Rules

Why This Topic Matters

ASC claims can be denied or underpaid when facility billing rules are confused with physician billing rules or when modifiers are applied inconsistently. Understanding the article helps billing teams align ASC and professional claims with CMS expectations and avoid preventable reimbursement problems.

Article Sections

1. ASC payment system update and reimbursement context

   Introduces the CMS quarterly update to the ASC Payment System and frames the article around common ASC reimbursement issues. It also identifies the types of payment-related content included in the update.

2. Know where to find ASC-allowed services

   Explains that CMS maintains a list of codes payable for ASCs and points readers to the relevant resource. The section emphasizes access to current and prior quarterly information.

3. Remember the same-day global rule

   Compares ASC facility reporting with physician reporting when services occur in the postoperative period. The section discusses how the ASC view differs from standard professional global period handling.

4. Properly append modifier SG

   Focuses on modifier placement and reporting order for ASC facility claims. It also illustrates how multiple procedures are handled on the ASC side versus the physician side.

5. Discontinued coding modifiers may differ

   Reviews discontinuation-related modifier use in the ASC setting. The section contrasts general reduced-service reporting with ASC-specific discontinued outpatient procedure reporting.

6. Keep in contact with the ASC

   Addresses the need for coordination between physician and ASC billing teams. The section notes that mismatched procedure reporting can create reimbursement problems.