ASC billing multiple procedure rule

Multiple Procedure Rule

As many pain procedures involve bilateral injections and/or multiple levels, each procedure can yield two to three facility fees. Medicare and other payers currently pay 100 percent of the highest payment for multiple procedures in a single session and 50 percent for each additional procedure.  Local Medical Review Policies and the Correct Coding Initiative apply to both professional fees and facility fees.

Fluoroscopy in ASC’s

Medicare facility fees include the use of equipment that is directly related to the provision of the surgical service. The technical component of the use of the C’arm is thus bundled into the Medicare facility fee payment.  The physician performing the procedure would indicate the professional component (modifier -26) on his claim for services rendered for both needle localization and supervision and interpretation studies.  The technical component would not be billed separately to Medicare on the ASC claim.

Modifiers – Recoup Costs

CMS approves two modifiers that can be used in the ASC to report discontinued procedures.

-73 Discontinued outpatient procedure prior to the administration of anesthesia
-74 Discontinued outpatient procedure after the administration of anesthesia