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ASC Multiple discount guidelines for 63650 62350 64575 63655 63661

Amani Posted Wed 28th of August, 2013 11:48:46 AM

Do you know if Medicare does not apply multiple discount when these procedures are done more than one time or in addition to other procedure on the same date of service. This is for ASC billing.

63650 62350 64575 63655 63661

Than you,

SuperCoder Answered Thu 29th of August, 2013 11:08:29 AM

Hi,

We are working on this case.

Thanks

SuperCoder Answered Thu 29th of August, 2013 11:08:29 AM
With me
SuperCoder Answered Tue 03rd of September, 2013 10:06:33 AM

Hello, and thanks for the question.

Since you say this is ASC billing, I'm answering based on the assumption that you're in a freestanding ASC facility. If that's the case, multiple procedure discounts won't come into play because you can't report all of the codes listed. Here's why:

Codes 63650, 63655, and 64575 are not approved for separate payment in a freestanding ASC. Codes 62350 and 63661 are both ASC approved procedures, but CCI edits bundle them as mutually exclusive. 63661 is a Column 2 code for 62350, and you aren't allowed to report a modifier and 'break' the bundle.

So, if you're billing for a freestanding ASC, only 62350 is billable.

Thanks again, and I hope that helps.

SuperCoder Answered Tue 03rd of September, 2013 10:06:33 AM
With me
Amani Posted Tue 03rd of September, 2013 11:27:53 AM

Thank you so much for your reply. the procedures I listed are not for one claim. For example I have on one claim with procedure 63685 and 63655. We pay according to Medicare Fee Schedule. both procedures are payable based on Medicare fee schedule. So my question was if I can discount 63655?on another claim, I have procedure 63650 listed twice...so my question, can I discount one?

Also I need clarification please why if an ASC is freestandng, procedure 63650, 63655, 64575 are not approved for separate payment?

SuperCoder Answered Thu 05th of September, 2013 13:48:22 PM

Please bear with us...we are researching this query.

SuperCoder Answered Thu 05th of September, 2013 13:48:22 PM
Leigh DeLozier: can you respond to their second query? thanks.
SuperCoder Answered Tue 17th of September, 2013 17:56:55 PM

Please refer to sections 10.2 (Ambulatory Surgical Center Services on ASC List) and 40.5 (Payment for Multiple Procedures) of the Medicare Claims Processing Manual, Chapter 14 - Ambulatory Surgical Centers. These may answer all your questions.
http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c14.pdf

I hope that helps!

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