ASGE members may submit coding inquiries electronically to codingquestions@asge.org. Each month ASGE gets dozens of questions from members. When submitting a question, please allow at least three business days for a response. When submitting inquiries, please include the ASGE member’s name and ID number. Only questions will be accepted and not reports. Below are two questions that could be beneficial to your practice.
Question #1
Our physician was looking to do Botox injection during EGD at our ASC which currently is solely done in the hospital setting. We believe we cannot do this in the ASC as we would have to bill on the facility side and not the physician (like a buy and bill). Are we correct that this would not be covered (the Botox part) at the ASC?
Answer
Botox is reimbursable to the ASC, however it most likely will not cover the total cost. You will find the approved amount in the Medicare ASC fee schedule under tab BB. It is reimbursed at $6.09 per unit. CPT codes J0585 is the HCPCS code. It is also recommended that you also check with your commercial payers regarding reimbursement as well.
Question #2
A patient comes for a procedure and, during pre-assessment, states they did not follow instructions and ate or drank. Can we bill with modifier 73 for ASC fee? Or is that only for situations where due to arrhythmias or other situations prevent continuation of sedation and procedure? Would it be better to just charge a missed / rescheduled appointment fee to the patient?
Answer
Unfortunately, modifier 73 does not apply in this situation. The patient would have to enter the endoscopy suite in order for the modifier 73 to apply, and it would have to be a medical condition that causes the cancellation of the procedure. This is where a missed/rescheduled appointment fee comes into play, and the patient needs to be instructed at the time of scheduling that any failure to comply with instructions could result in a cancellation fee.