Dermatology Coding Alert: Master Your Derm ASC Coding

Numerous changes affecting ASCs every year are enough to confuse you. Still, few aspects of ASC reimbursement continue to be the same. Read further to know how the ASC rules affect you and what dermatology codes you should choose in such a case. These expert tips will surely take you a step ahead in perfecting your dermatology medical billing and coding.

1. ASC-allowed services: Know where to find them. CMS has a very specific list of codes payable for ASCs, but if you don't know how to access the list, you could be losing your reimbursement.

You can download the most recent ASC-allowable codes from the CMS website. It includes both the current quarter as well as previous quarters in case you're battling older claims.

2. 'Same-day global' rule. Each procedure the ASC bills takes a "same-day" global period as the ASC is only reporting facility fees and not physician work services. This is applicable to the coder working for the ASC and not the physician who performed the service.

In case the physician returned the patient to the ASC the day after the initial surgery, the ASC coder is supposed to report the suitable control-of-bleeding code with no modifier. 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.

The ASC coder should go by the "same-day" global rule, but the physician's coder should follow standard global period rules from the fee schedule.

3. You Can Avoid modifier SG. In the past, the ASC coder had to list modifier SG (ASC facility service) as the first modifier on the claim in case he billed Medicare for any service performed in the ASC. However, that all changed with the CMS Transmittal 1410, which stated that the SG modifier is no longer applicable for Medicare services for services on or after January 1, 2008.

4. Discontinued surgery modifiers may differ. ASC coders may sometimes use modifier 52 (Reduced services) but would not use modifier 53 (Discontinued procedure). Instead, insurers generally want ASC coders to call on modifiers 73 (Discontinued outpatient hospital/ASC procedure before administration of anesthesia) or 74 (Discontinued outpatient hospital/ASC procedure after the administration of anesthesia), as appropriate.

When the physician gets back to the ASC with the patient to perform the aborted procedure at a later date or time, the ASC will get full reimbursement for the completed procedure.

5. Keep in contact with the surgeon's coder. You could lose your reimbursements when the physician and the ASC report separate codes for the same procedure. Remember, the physician and ASC should report the same codes for each surgery, any coding differences should be fixed before the claim is submitted.

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