HCPCS Status Indicators vs Payment Indicators

[louise]

Help!
I am really struggling with ASC Status Indicators and ASC Payment Indicators as listed in the front of HCPCS. Does it only have to do with whether the Ambulatory Surgical Center is 'hospital-owned' (and therefore the same as any hospital outpatient facility) or a 'free-standing' ASC?

 

[Laureen]

Hi Louise,

That's a good question. It is my understanding they are just used with Ambulatory Surgical Centers. The following pages on the CMS.gov website may help:

http://www.cms.gov/Center/Provider-Type/Ambulatory-Surgical-Centers-ASC-Center.html
http://www.cms.gov/Medicare/Medicare-Fee-for-service-Payment/ASCPayment/index.html

And from this page https://questions.cms.gov/faq.php?id=5005&faqId=2305 the following excerpt:
What procedures and services are payable when performed in the Ambulatory Surgical Center (ASC) setting under the revised ASC payment system?
Under the ASC payment system, Medicare will make facility payments to ASCs only for the specific ASC covered surgical procedures on the ASC list of covered surgical procedures published in Addendum AA of the hospital outpatient prospective payment system (OPPS)/ASC final rule for the relevant payment year. Addendum AA to the calendar year (CY) 2008 OPPS/ASC final rule is available at http://www.cms.hhs.gov/ASCPayment/ASCRN/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=3&sortOrder=descending&itemID=CMS1213395&intNumPerPage=10. In addition, Medicare will make separate payment to ASCs for certain covered ancillary services that are provided integral to a covered ASC surgical procedure. Covered ancillary services include the following:

• Brachytherapy sources;
• Certain implantable items with pass-through status under the OPPS;
• Certain items and services that CMS designates as contractor-priced, including, but not limited to, the procurement of corneal tissue;
• Certain drugs and biologicals for which separate payment is allowed under the OPPS; and
• Certain radiology services for which separate payment is allowed under the OPPS.

Other non-ASC services such as physician services and prosthetic devices may be covered and separately billed under Medicare Part B. See the Medicare Claims Processing Manual, Chapter 14, Section 10.2 for more information.

(FAQ2305)

 

[louise]

Oh my! Laureen, thank you for your reply. Yes, CMS has got lots to say about what is allowed to be performed in an ASC. They even have a list of what's NOT allowed!
What's really puzzling me is the implied distinction between two different kinds of ASCs.... "hospital-owned" and "free-standing".
CMS sure doesn't seem to point out the distinction, but my study materials do. It's unclear though whether there is really any difference between them except for the use of the TC modifier and reporting E/M.
And then there are the Payment Indicators and Status Indicators, both listed in the front of HCPCS. They are both for ASCs, but how are they different, or how should one know which Indicators to use? There are no guidelines that I can find.

 

[Laureen]

I'm afraid I don't know a detailed answer to that. The POS (place of service) code would be different. POS 24 is for a free standing ASC. POS 22 is for hospital owned (paid under hospital payer contracts). I suspect that changes the rates paid but I think the coding would be the same.

Here is a presentation I found in my google searching that seemed pretty good ASC Coding and Billing Fundamentals. I didn't see much discussion about free-standing vs. hospital owned so I don't think it has a huge impact on coding.

If you're an AAPC member you might find more detailed help from ASC coders that seem to be on this forum https://www.aapc.com/memberarea/forums/forumdisplay.php?f=438

 

[louise]

Your effort is so appreciated Laureen. This is really helpful. I have some work to do...
All you folks out there, we have quite a fabulous resource in Laureen, raise your glasses!