Billing for Hospital and Ambulatory Surgery Centers
When it comes to medical billing, the procedural codes are extremely important in order to maintain accuracy and efficiency in the billing process. The billing codes and processes change according to the type of procedures being performed and the facility at which they are performed.
Ambulatory Surgery Center Billing
There are two different types of codes to consider when billing medical procedures. The first is the ICD-10-PCS, which outlines inpatient procedures performed on patients. The other is the Current Procedural Terminology (CPT), which provides information about rendered services rather than claims for insurance. These are often used in conjunction with the ICD-10 codes.
CPT codes are used in both hospital and ambulatory surgery centers, but ambulatory surgery centers use the CPT codes in place of the ICD-10 codes. CPT codes follow a different system than the ICD-10-PCS. The ICD-10-PCS categorizes procedures into seven alphanumeric characters, each denoting a specific aspect to the procedure. The CPT codes, on the other hand, are split amongst three categories, the first of which has six subcategories. These include:
- Category I – These are codes that deal with these subcategories: codes for evaluation and management (99201-99499), codes for anesthesia (00100-01999; 99100-99150), codes for surgery (10021-69990), codes for radiology (70010-79999), codes for pathology and laboratory (80047-89398), and codes for medicine (90281-99099; 99151-99199; 99500-99607).
- Category II – These codes that incorporate measurements, have an alphabetic character as its fifth character, and are listed as $0.00 as a billable charged amount.
- Category III – These codes deal with emerging technologies in the field.
Billing for hospital stays and procedures can only use the ICD-10 book of codes if the procedures are performed as inpatient procedures, meaning there is at least a day of recovery time in the hospital.
For instance, if there was a patient who needed to be monitored in the hospital for cardiac output, the billing code according to the ICD would be 4A1209Z, where “4” marks the section as Measurement and Monitoring, “A” represents physiological systems, “1” represents the root operation as Monitoring, “2” denotes the heart as the body part being monitored, “0” shows that it is an open approach, “9” shows that is monitoring output, and “Z” indicates that no further qualifiers are needed.
CPT codes are also used in hospital billing. However, they differ in several ways. For one, the CPT codes can be seen by physicians, patients, and billers, as well as insurance companies.
Ambulatory Surgery Center Billing
An ambulatory surgery center is also known as an outpatient procedure center. In an ambulatory surgery center, procedures are performed on patients and are completed the same day, to a point where the patient can leave the facility immediately following surgery.
Ambulatory surgery centers use CPT codes when billing insurance agencies for patient visits. The codes 99201-99215 are designated for outpatient procedures. Each code is designated to a specific patient who meets specific criteria.
For example, if a new patient comes in for an outpatient procedure he or she will be billed using one of the following codes: 99201, 99202, 99203, 99204, or 99205. The differences between these codes lie in the amount of time a physician spends with that patient before the surgery. That time is billed differently.
If the patient coming in for an outpatient procedure is not a new patient, he or she will be billed according to one of the following codes: 99211, 99212, 99213, 99214, or 99215. The differences between these codes lie also in the amount of time spent with a patient before he or she has his or her procedure.
Both hospital billing and billing for ambulatory surgery use CPT codes in order to bill the procedures correctly. ICD-10 codes can only be used in cases of inpatient procedures. Knowing the code and to what procedure the codes correspond allows for more extensive and specified billing services.