10 Ambulatory Surgery Center Coding Tips to Know for 2024

Posted By the Surgical Notes Coding Department

Proper coding is essential for ambulatory surgery centers. Correct ASC coding increases the likelihood that surgery centers will get paid accurately and promptly. Coding mistakes, on the other hand, are likely to cause problems for ASCs, including increases in denials, wasted time and resources, possible loss of revenue, and even fraud investigations if there is suspicion of intentional incorrect coding for the purposes of boosting reimbursement.

To help your ASC improve its coding accuracy in 2024, follow these tips.

1. Use complexity adjustment code combinations

Last year, CMS implemented new temporary C codes to replace certain service codes and add-on codes. Historically, the use of these add-on codes has not resulted in additional payment from CMS since they are considered "packaged" codes. The 55 new C codes increase the payable amount to the facility, making their use beneficial for ASCs to understand.

These codes only apply to the ASC claim. Physicians should continue to report the individual CPT codes instead of the C codes. Also, if only the primary service code is performed without the add-on code, the C code should not be used. Only use the primary service code. While these C codes are primarily used by CMS for Medicare claims, check with your commercial carriers for potential coverage as well.

There are many code combinations, so familiarize yourself with the new codes that apply to your specialty(s). The full list of codes with crosswalk can be found on the CMS website.

2. Differentiate screening colonoscopy post positive stool-based test

CMS now requires the use of a -KX modifier to differentiate a colonoscopy performed following a positive stool-based test. Also referred to as a "follow-on colonoscopy," CMS notes this procedure is an important part of the screening process and patient cost sharing will not apply. Frequency limitations for screening colonoscopies also won't apply to a screening colonoscopy that follows a positive test result. Check with commercial carriers for their specific requirements concerning follow-on colonoscopy.

3. Follow billing rules for multiple respiratory endoscopic procedures

If medically reasonable and necessary endoscopic procedures are performed on two regions of the respiratory system with different types of endoscopes, both procedures may be separately reportable. For example, if a patient requires a bronchoscopy to evaluate a lung mass and a separate laryngoscopy to biopsy a laryngeal mass, both may be reported. It was medically necessary to use two separate endoscopes to perform both procedures.

Such information must be clearly and accurately documented to be supported. If there is not a separate indication or medically necessary reason for the diagnostic bronchoscopy in addition to a surgical laryngoscopy, then only the laryngoscopy may be reported.

4. Ensure physicians document device procedures with clinical terms

For physicians documenting procedures that include devices, it's important to understand what impact devices have on code selections. Rather than titling procedure by the device used (e.g., Omni procedure), physicians should use the clinical term for it (e.g., dilation of Schlemm's canal). This will help coders accurately identify the correct procedure performed and avoid confusion or possible queries if they do not understand how the device translates to the performed procedure.

5. Select CPT codes for extraarticular fractures by type of treatment

CPT selection for extraarticular fractures should be based on the type of fracture treatment required (closed, percutaneous, or open). Choose from the following:

CPT 25605 — Closed treatment of distal radial fracture (e.g., Colles or Smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; with manipulation
CPT 25606 — Percutaneous skeletal fixation of distal radial fracture or epiphyseal separation
CPT 25607 — Open treatment of distal radial extra-articular fracture or epiphyseal separation, with internal fixation

6. Understand how coding open fractures differs from extraarticular fractures

CPT selection for intraarticular fracture coding should still be based on the type of fracture treatment required, but there is an added element for open fracture treatment: number of fragments receiving internal fixation. In addition to CPT 25605 for closed treatment and CPT 25606 for percutaneous treatment, intraarticular fractures may also be coded with the following codes:

CPT 25608 — Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 2 fragments
CPT 25609 — Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 3 or more fragments

Documentation to specify the number of fracture fragments being fixated is important. It is not sufficient for the physician to only state there were three fragments in the diagnosis field. The details of the procedure must include the specifics of what is being performed. If this information is omitted, the coder will need to query the physician for additional information and/or confirmation.

7. Know how sinus anatomy affects coding

There are four sinuses: ethmoid, sphenoid, frontal, and maxillary. CPT and ICD-10-CM code selections depend on which sinuses are treated, whether one or multiple sinuses are treated, and the techniques used by the performing surgeon.

8. Use updated ICD-10-CM diagnosis codes

New ICD-10-CM diagnosis codes went into effect on Oct. 1, 2023, for fiscal year 2024. There are few code revisions that will affect ASC coding. The following are some of the new codes ASCs should know about:

Desmoid tumors (D48.110 – D48.119)
- Specific to anatomic locations (e.g., chest wall)
Parkinson’s disease (G20.A1 – G20.B2)
- With and without dyskinesia
  - With and without fluctuations
Chronic migraine with aura (G43.E01 – G43.E819)
- Intractable and not intractable
  - With and without status migrainosus
Ocular muscle entrapment (H50.621 – H50.689)
- Specific codes for each ocular muscle
Osteoporosis with pathological fractures (M80.0 B1A – M80.8B9S)
- Age related and other osteoporosis
  - With pelvis fractures
Family history of colon polyps (Z83.710 – Z83.719)
- Type of polyps

There are ICD-10-CM changes to other body system diagnoses as well. Review and determine which new codes and changes are applicable to your ASC and then educate your staff and update any reference documentation as needed.

9. Choose carefully between CPT 55700 and 55706 for prostate biopsies

The coding of prostate biopsies can be nuanced. It is important to recognize and distinguish the work associated with the different CPTs for these procedures as doing so will help ASCs obtain authorizations and anticipate the correct reimbursement.

CPT 55700 and 55706, used for prostate biopsies, are similar.

55700 — Biopsy, prostate; needle or punch, single or multiple, any approach
55706 — Biopsy, prostate, needle, transperineal, stereotactic template guided saturation sampling, including imaging guidance

There are four noteworthy differences between these codes:

Approach — 55700: any approach | 55706: transperineal approach
Anesthesia — 55700: local anesthesia | 55706: general anesthesia
Number of biopsies — 55700: 6-12 biopsies | 55706: 35-60 biopsies
Use of template/grid — 55700: no template or grid needed | 55706: requires use of template or grid to perform systematic collection of specimens from the entire prostate gland

The surgeon should document the use of a template or grid and indicate the number of specimens obtained to help with improving code assignment accuracy.

10. Stick to the rules for varicose veins

ICD-10-CM codes for varicose veins are categorized by symptoms and complications associated with the varices. If the patient suffers from pain, inflammation, or other conditions, include this information in your documentation to support the highest specified code.

Phlebectomy procedures are coded based on the number of incisions performed on each leg. Documentation of the exact number of incisions performed will stand up best if audited and allow for accurate coding. If fewer than 10 incisions are performed on an extremity, the procedure is considered unlisted and will not be reimbursable in the ASC.

Improve ASC Coding With Surgical Notes

If you are struggling with achieving the high levels of coding accuracy and efficiency needed to achieve strong revenue cycle performance, consider outsourcing your ASC coding and billing to Surgical Notes, the premier surgery center revenue cycle management and billing services partner. You can also help improve your performance by staying current on ASC coding developments and receiving tips by following Surgical Notes on LinkedIn.

Categories: ASC News