tci Outpatient Facility Coding Alert - 2013 Issue 12
You Be the Coder: Extra Payment for J0171
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Article Overview
This article addresses a Medicare claim-denial question involving epinephrine reporting during surgery and explains the relevant ambulatory surgery center payment context. It is intended for coders and billing staff who work with HCPCS drug reporting, Medicare payment rules, and ASC claims processing.
Why This Topic Matters
It helps readers understand why a claim may be denied or not separately paid in the ambulatory surgery setting and highlights the importance of HCPCS status indicators for reimbursement review.
What You Will Learn
- How the article frames a Medicare denial question for a drug billed during surgery
- How HCPCS status information is used in the ambulatory surgery setting
- Why a reported drug may be retained for documentation or data purposes even when separate payment is not made
- What general claim-processing issue the article discusses for ASC billing
Who Should Read This
- Medical coders
- Billing staff
- ASC reimbursement specialists
- Revenue cycle personnel
Codes Discussed
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