ASC Payments: These 5 Tips Will Make Your Derm ASC Coding A Snap

Check out the new 2011 payment rates for dermatology procedures performed in an ambulatory setting.

True or false: Modifier SG is required for all ambulatory surgical center (ASC) claims.

The answer is false for claims with dates of service after Jan. 1, 2008 -- and if you got that one right, you're on your way to ASC reimbursement bliss.

CMS has issued its latest quarterly update to the ASC Payment System, which includes HCPCS codes , modifiers, drugs and supplies that are payable for ASCs effective April 1.

With so many changes affecting ASCs every year, it's enough to make your head spin -- but despite all of the changes, some aspects of ASC reimbursement have remained the same. We've got the lowdown on how the ASC rules affect you.

1. Know where to find ASC-allowed services. CMS maintains a very specific list of codes payable for ASCs, but if you don't know how to access the list, you could be flying blind when it comes to reimbursement.

Resource: You can download the most recent ASC-allowable codes at www.cms.gov/ASCPayment/11_Addenda_Updates.asp, which includes not only the current quarter (which began on Jan. 1), but also any previous quarters in case you're battling older claims.

2. Remember the 'same-day global' rule. Every procedure the ASC bills has a "same-day" global period. This makes sense because the ASC is not reporting physician work services -- only facility fees. This applies to the coder working for the ASC, but not the physician who performed the service.

For instance, if a patient experiences postoperative bleeding after the repair of a superficial wound (12001-12018, Simple repair of superficial wounds …) and the physician must return the patient to the ASC for control of bleeding on the same day, both the physician's coder and the ASC's coder should report the appropriate control-of-bleeding code appended with modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified healthcare professional following initial procedure for a related procedure during the postoperative period) because the procedure occurred within the "same-day" global period for the ASC.

If, however, the physician returned the patient to the ASC the day after the initial surgery, the ASC coder would report the appropriate control-of-bleeding code with no modifier. For the ASC's purposes, the initial surgery's global period has expired, even though the surgery includes a 90-day global period for physician services. On the other hand, the surgeon's coder would report the bleeding-control code with modifier 78 appended because the physician's services follow the standard global rule.