Anesthesia for Nerve Blocks - Modifiers for Facility vs ASC

jacobc@gcrmc.org

Hello,

Our CFO is being told by our contract Anesthesia service that the reimbursement for Anesthesia is 8 times greater on the facility side than with an Outpatient Surgery Center for Anesthesia performed for nerve blocks. Is there any specific modifiers anyone is aware of that would distinguish the billing between the facility and surgery center billing, because I am not finding anything that would prove this statement to be true. 

Thank you,
Jacob Chavez, COC

RHirsch

Are they talking about the professional fee or the facility fee? Either way, the place of service on the claim determines which fee schedule is applied 22 or 24 for outpatient hospital v ASC

jacobc@gcrmc.org

They are talking about a professional fee, which is why it's confusing, because I don't bill out any CPT code codes on the facility side, as the coding is solely for professional reimbursement. This lead me to question if we should be performing the case in the facility, to be able to bill with the facility POS, vs the ASC?

RHirsch

So, if the physician owns the facility, like an office, then they bill the global service. They get paid a fee that includes the facility charges and prof fee. If they do it in an ASC or hospital outpatient surgery area or clinic, the facility bills and gets paid for the facility fee and the physician gets the prof fee. The difference can be substantial because the facility costs can be substantial. But the physician cannot get the facility fee if they did not provide the facility services as an owner. 
For example, 64479 pays a $150 prof fee if done in an ASC but $300 if you bill for the whole thing- prof and facility. 
For a doctor who does stenting in legs, which is permitted in office setting in certain circumstances, the prof fee is $400 but the global fee is $4,000. But you can't bill what you did not provide.

Maybe I am totally missing the question but maybe not.