Forum - Questions & Answers

Apr 18th, 2015 - aamir

Pain management procedure billing at ASC (surgical centers)

I am helping a Pain management physician in procedure coding and have some questions. The doctor has vested interest in an ambulatory surgical center. He performs ESI / pain management injections at the ASC. CPT® code 62310 for example. He wishes to bill this code for his professional service while the facility bills for their facility fee. Is it ok for him to bill this code and other procedure codes or is it the surgical center that bills the procedure codes while he can only bill for Epidurography Please remember that the ESI codes cannot be billed with a 26 modifier. In the past I have done billing for an outpatient heart catheterization lab for left heart cath, atherectomy etc with a procedure code and a 26 modifier for the doctors services and gotten paid, while the cath lab billed the same code with a TC modifier. However, I am not clear if we bill the pain management code globally via the doctors office and get paidwhile the surgical center still bill the same code simultaneously and also get paid at the same time.

A'amir Shaikh,
Practice Manager

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Apr 21st, 2015 - LBAROGIANIS 250 

re: Pain management procedure billing at ASC (surgical centers)

Is the ASC billing on a UB04? If so, then the physician bills the same code on a CMS 1500 form. Companies know that the UB04 gets facility rates and 1500 form gets physician rates.

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