What is Ambulatory Surgery Center ASC Billing and Coding?

Touseef Riaz

November 28, 2022

ASC Billing

ASC Billing (Ambulatory surgery centers) are specifically designed to perform outpatient surgical procedures and are also known as day surgery centers. These centers offer general surgery, neurosurgery, ophthalmology, and orthopedics.

ASC Billing and Coding

Ambulatory surgeries have become an increasingly popular option for patients who need surgery. Still, they cannot travel long distances or wait several weeks for an appointment at a hospital or physician’s office. The average ASC can treat up to 10 patients daily; however, some offer more than 50 treatments per week!

Ambulatory surgery centers (ASC) are medical facilities that provide ambulatory surgical services. The ASCs help improve patients’ quality of life and increase access to treatment in a convenient setting. Most ASCs have been located in hospitals, but over time they have developed into stand-alone facilities that provide outpatient surgeries and other outpatient procedures to patients. In addition, ambulatory surgery centers are often off-site locations where patients receive care while they travel from various locations within an urban or suburban community. This can include visits from their homes, workplaces, or other public places like libraries or malls during their stay at the center. It makes them more mobile than traditional hospitals and cheaper for healthcare providers/patients since there are no fixed costs associated with maintaining buildings, etc.

Ambulatory Surgery Center Billing

An ambulatory surgery center (ASC) is a facility that provides outpatient surgical services, such as outpatient cataract removal and bone fusion. In addition, these facilities call day surgery centers, where outpatient surgeries are carried out.

ASCs can be private or public and may offer general and specialty surgical procedures. They usually have an onsite pharmacy and an ancillary staff that includes a nursing team, a social worker/case manager, dietitians/nutritionists, and technicians who perform patient care tasks such as cleaning or preparing patients for surgery. ASCs also may offer medical imaging services like CT scans or MRI scans; some even offer cardiac rehabilitation programs after heart attacks occur through their hospitals.

What are Medical Billing and Coding?

Medical billing and coding transcribe patients’ assessment, diagnosis, and treatment plans into the alphanumeric CPT code designed by the ICD 10 classification. This coding will help physicians to get their medical bills paid by Medicare or a third party smoothly.

Medical billing can be done manually or computerized through an automated system called a medical record management system (MRMS). The MRMS is an intermediary between providers and insurers, providing information about patients’ conditions and treatments necessary for reimbursement purposes.

ASC billing is a complex process that requires highly skilled professionals. The medical billing specialist must be able to make sure that all the information provided by physicians and other medical professionals is accurate. This means they must have excellent attention to detail and solid knowledge of coding systems such as ICD-10, CPT, and HCPCS.

The ASC billing guidelines are described below.

Ambulatory Surgery Center Coding

Ambulatory surgery centers’ billing professionals assign CPT codes to a surgical procedure according to the ICD-1o classification system.

CPT is the main code used by physicians and hospitals when they bill for medical services. The CPT codes classify and describe various procedures performed during a surgical visit, including those in which no anesthesia was provided.

 How to find the CPT codes for your ASC billing facility? 

Determine the Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System(HCPCS) code assignment requirements for each specialty surgery. The information you need to collect includes the following:

  • Description of service – What is being done? How many times will it be performed? Is this a new procedure, or do you serve it occasionally but not regularly? If so, how often will you accomplish this service in your practice?
  • The interval between procedures. How often should patients receive follow-up visits after their first procedure? How often should they receive follow-up visits after each successive procedure performed by you/your staff (for example: if a patient has three procedures performed with no interval in between)?
  • Analyze specialty services provided in the ambulatory surgery center.
  • Type of anesthesia used during an operation (if applicable.)
  • In this way, you can make a list of the CPT codes according to the services of your ambulatory surgery center.

How do we identify the CPT codes for each type of surgery?

CPT is the standard coding system used by physicians, other healthcare providers, and suppliers to report medical services and procedures performed. The second step is determining the current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System(HCPCS) code assignment requirements for each specialty service.

For example, the procedure description may be obtained from an operative report or pathology report that includes the following information:

  • Date of surgery;
  • Purpose of surgery;
  • Total number of patients who had this type of surgery performed during the last 30 days at this hospital/facility;
  • Name(s), address(es), phone number(s), and fax number(s) (if any).
  • The patient data that can be collected from each encounter include: age; sex; race/ethnicity (if applicable); date of birth; medical history related to physical examination findings, including allergies; medications being taken at the time of encounter (including drug allergies); anesthesia type(s) used during surgery if applicable; diagnostic testing performed onsite before or after surgery per International Classification of Diseases (ICD-9-CM), ICD-10 CM codes.

Create the Bill

  • Enter pertinent data into the appropriate form or computer system to create a bill (charge slip).

Verify all Requirements of Documents

  • Verify that all the specific requirements for correct patient identification, provider signatures, necessary authorization information, etc., are present. Please verify that you have reviewed your documentation and ensure it meets all coding requirements as listed in your local CPT manual or CMS paid-code manual.
  •  Locate and verify the eligibility of insured patients using Internet-based system resources before billing; this includes verifying eligibility and benefits within two business days of receipt of that information by fax, mail, telephone, or Internet transmission.
  • Verify the patient’s insurance coverage before beginning treatment. This is crucial in avoiding additional charges for services not covered by the patient’s plan or for which payment may be required later. It also helps ensure that your facility knows which types of insurance are accepted at your practice location.

What is the benefit of using CPT Codes in Ambulatory Surgery Centers?

The benefit of using CPT codes in ambulatory surgery centers

  • It helps in the uniform coding of surgery procedures all over the united states.
  • It facilitates billing by providing standard diagnostic and therapeutic services, systems, and supplies that all ambulatory surgery centers can use.

What is an Ambulatory Surgery Center Modifier?

If your ASC billing is a hospital-based facility, you must file your claim of CPT code with surgery modifier. If you file without the SG modifier, you may receive the fee schedule amount for the surgery instead of payment from the group rate for the facility fee.

How your Ambulatory Surgery facility can be Certified by Medicare?

Suppose you want that Medicare should cover your ambulatory surgery facility. But, first, you must know how to meet all the requirements for conditions for the coverage set by Medicare.

Medicare covers certain surgeries such as gallbladder removal, hip replacement, and knee or shoulder replacement. However, some surgeries aren’t included in this program because they require more than one procedure during their duration (for example, colonoscopy).

The main advantage of the ambulatory surgery center that Medicare covers are that it reduces out-of-pocket expenses. You won’t have to pay for any medical services or supplies unless you are fully covered by insurance. This can be an exceptional benefit for people who don’t have good health insurance coverage.

The ambulatory surgery center that Medicare covers also has some limitations. The first limitation is that you may not be able to get the best medical care if you go here. For example, suppose you have a severe condition such as heart disease or lung cancer and need surgery. In that case, you should go to an inpatient facility where specialists can better diagnose your condition and treat it appropriately.


Ambulatory surgery centers are outpatient facilities that provide treatment for patients who have had surgery. These facilities typically offer different services, from medicine to cosmetic surgery, but they’re primarily known for their surgical capabilities. Ambulatory surgery centers can be found in many other locations worldwide and are often referred to as “surgery centers.”

As you can see, ASC billing and coding is a complicated process. But, if you’re looking for a medical billing company that offers quality services at an affordable price, then look no further. U Control Billing is the best choice for those who want to get the most out of their healthcare bills. At U Control Billing, we take pride in our customer service and ability to meet all your needs. 

If you’re unsure about what needs to happen next, don’t hesitate to ask for help! Our team is ready with expertise in all areas of healthcare finance, including CPT codes and billing procedures. They’ll also assist with any questions or concerns that come up during your work on the project.


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