ASC Surgical Billing Services

General surgery represents, on average, slightly over 5% of surgery center procedures (per the ASC Association). However, general surgery is a much bigger portion of procedures for many ASC’s and frequently represent the “marquee” business for a center. Medicare’s ongoing addition of procedures it will reimburse in an ASC setting continues to accelerate the growth of ASC surgical procedures. For example, the addition in 2008 of laparoscopic cholecystectomy to the list of approved procedures followed by laparoscopic hernia repairs in 2009. Continued improvements in technology and anesthesia are also driving growth in ASC surgical procedures. And patients are increasingly receptive to outpatient surgical procedures as they find the environment of an ASC more attractive than many hospital settings.

Skills required for ASC Surgical Billing

Billing for ASC surgical procedures can be complex. General surgery, by definition, represents a wide variety of procedures and underlying causes (diagnoses). Often rules vary by payer (e.g. modifiers). As a result, it is recommended that only experienced surgical coding and billing staff be employed. To perform effectively, billing staff must be knowledgeable in coding, charge posting, claims filing, payment posting, customer service, A/R follow-up including denial management, and reporting.

For many centers, finding and retaining these skills in a relatively small staff can be a challenge. For this reason, hiring a firm who specializes in ASC surgical billing may be the best option. The right firm offers an ASC the ability to hire a team of experts, specialized and skilled in each of the billing disciplines, while only paying for a fraction of the costs. Since a professional ASC billing company performs coding and billing for many ASC’s, economies of scale are realized and passed along to clients. The volume of work justifies having specialists and experts and avoids the risk that an ASC faces with internal staffing: “jack of all trades, but master of none.”

ASC General Surgery Billing Considerations

Insurance underpayments are an issue for all specialties, but they can be particularly common, and troublesome, for ASCs with substantial volumes of general surgery. Underpayments can represent 5%, 10% or more or a surgery center’s revenue. Capturing all of the supplies used and assuring that they are reimbursed, where allowed, is one example.

As everyone knows, coding rules are constantly changing. The addition of new surgical procedures (and their associated codes) is important. However, careful coding of common surgical procedures is equally important. Many centers even perform a certain number of procedures that can be performed in an office setting (e.g. hemorrhoid treatments) for both patient and surgeon convenience.

In all of these cases, it is critical that coders carefully review the operative note to make sure they’ve accurately and completely captured exactly what was done. In some cases, multiple procedures are performed in one operative session. And coders must assure that HCPCS and CPT codes are not only accurate but also consistent. Post operative pain blocks provide another example. Some Medicare LCD’s (Local Coverage Determination) describe pain blocks as medically necessary but go on to say that they are not separately payable (of course, LCD’s vary by intermediary and carrier), while other states rely on the CMS NCCI Manual directive. On the other hand, some commercial payers do pay separately but have different reporting requirements.

Patient billing is also complex for surgical ASCs. Procedures that are perceived to be expensive (an average charge of over $4000 per case according to VMG Health, LLC), complicated payor explanations, and bills from other specialists (e.g. anesthesiologist) often lead to confusion. Billing staff and procedures built to offset these roadblocks can be much more successful in collecting patient balances in a timely manner.

Selected ASC General Surgery Procedures

Is your ASC performing many or most of these procedures?Are you confident that you are being fully reimbursed? If not, ask us about a free surgery center financial analysis.

Laparoscopic cholecystectomy. (47562)
Laparoscopic cholecystectomy with contrast study of the bile ducts through the scope. (47563).
Laparoscopic cholecystectomy with contrast study and exploration of common bile duct. (47564)
Prim art mech thrombectomy (37184)
Venous mech thrombectomy (37187)
Destruction of internal hemorrhoid(s) by thermal energy (eg, infrared coagulation, cautery, radiofrequency). (46930)
Percut ablate liver rf (47382)
Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when performed); reducible (49652)
Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when performed); incarcerated or strangulated (49653)
Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); reducible (49654)
Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); incarcerated or strangulated (49655)
Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); reducible (49656)
Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); incarcerated or strangulated (49657)

Note: CPT codes are copyrighted by the AMA.