10 Ambulatory Surgery Center Coding Tips to Know for 2023

By the Surgical Notes Coding Department

Coding mistakes can cause a number of problems for ambulatory surgery centers. They lead to increases in denials and wasted time and resources. Downcoding errors can cause ASCs to leave money on the table while upcoding errors can trigger fraud investigations if there is suspicion of intentional incorrect coding.

To help your ASC reduce coding errors in 2023, follow these tips.

1. Understand the modifiers for canceled procedures. If a procedure is canceled in the operating or procedure room before it's started, coders should code the planned procedure with the appropriate modifier to indicate the anesthesia status. Use modifier -73 for procedures discontinued prior to the administration of anesthesia. Use modifier -74 for procedures discontinued after the administration of anesthesia.

If multiple procedures are planned but none are performed, only the primary procedure is reported with the appropriate modifier. If one procedure is completed and a second is started but not completed, code the first procedure with no modifier and report the second procedure with modifier -74. Any additional planned procedures not started are not reported.

2. Avoid unspecified HCPCS implant codes. Before submitting a claim to a carrier, or when working an appeal, always review your implant HCPCS code. If a generic code was used (e.g., L8699), check to see whether a more specific code can be used. Ensure you follow the payer's specific requirements.

3. Code arthroscopic rotator cuff repairs identically. Whether a rotator cuff tear is acute or chronic, arthroscopic rotator cuff repairs are always reported identically using CPT 29827 (Arthroscopy, shoulder, surgical; with rotator cuff repair).

4. Code open rotator cuff repairs differently. Open rotator cuff repairs require documentation to indicate whether the tear is acute or chronic. Use CPT 23410 for acute repairs. Use CPT 23412 for chronic repairs.

5. Closely review the operative report when coding esophageal dilations. Proper coding of esophageal dilations requires coders to understand the type of dilation performed. There are many CPT choices for coding esophageal dilations, including CPT 43248 (Esophagogastroduodenoscopy (EGD) with insertion of guidewire followed by passage of dilator through esophagus over guide wire); CPT 43450 (Dilation of esophagus by unguided sound or bougie (may or may not be done in the same setting as an EGD, which is separately reportable); and CPT 43453 (Dilation of esophagus over guide wire).

6. Understand the expanded endometriosis codes. For fiscal year 2023, all endometriosis codes were expanded to include several more specific locations and the depth of the lesion(s). To ensure the correct and most specific code is used, look up the diagnosis in the ICD-10-CM index and then review the code selection in the tabular.

7. Remember to use the subchondroplasty code. In 2022, subchondroplasty procedures were assigned their own CPT code (they were previously unlisted). That CPT code is 0707T (Injection(s), bone-substitute material (eg, calcium phosphate) into subchondral bone defect (ie, bone marrow lesion, bone bruise, stress injury, microtrabecular fracture), including imaging guidance and arthroscopic assistance for joint visualization).

8. Use the new drug-induced sleep endoscopies code. For drug-induced sleep endoscopies, don't forget to use CPT 42975 (Drug-induced sleep endoscopy, with dynamic evaluation of velum, pharynx, tongue base, and larynx for evaluation of sleep-disordered breathing, flexible, diagnostic). This code was introduced in 2022.

9. Choose the correct eustachian balloon dilation code. There are two codes for eustachian balloon dilations. The difference: one is for unilateral procedures; the other is for bilateral. These codes are as follows:

• 69705 — Nasopharyngoscopy, surgical, with dilation of eustachian tube (ie, balloon dilation); unilateral
• 69706 — Nasopharyngoscopy, surgical, with dilation of eustachian tube (ie, balloon dilation); bilateral

10. Avoid eponyms. Better documentation in an operative report translates to faster — and, more importantly — more accurate coding. That's why it's advisable to always document the details of procedures and all anatomy involved instead of just naming the procedure. For example, rather than documenting, "I then performed a Mumford procedure," detail the amount of distal clavicle removed in centimeters or millimeters and include the method(s) of removal. As another example, for Austin/Akin bunionectomies, document the location of any osteotomies.

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