ASC facility billing is its own animal: payment groups, implant logs, multi-specialty days. Facility revenue is separate from physician revenue and carries its own rules. We run ASC books separately and correctly.
We see the same patterns across ambulatory surgery centers groups. The leaks are specific, recurring, and fixable with coding discipline and payer-aware claim construction.
Not a complete list. A representative slice of the codes that drive revenue and denials for ambulatory surgery centers practices.
| Code | Description | Profile |
|---|---|---|
| 29826 | Shoulder arthroscopy, decompression | High volume |
| 29881 | Knee arthroscopy with meniscectomy | Modifier-sensitive |
| 42830 | Tonsillectomy | Denial-prone |
| 52000 | Cystoscopy | High volume |
| 43239 | Upper endoscopy with biopsy | Modifier-sensitive |
| C1713 | Anchor, bone | Denial-prone |
| C1762 | Connective tissue, human | High volume |
ASC facility claim separated from physician claim. Medicare ASC payment groups applied. Implant log maintained and cross-checked against claim. Pass-through devices identified and billed (C codes). Multi-specialty case days balanced for payer rules.
Pattern we see. Implant log mismatch with claim, POS error (24 vs 22), and pass-through device denied for missing C-code documentation.
How we fix it. Every denial is logged against its CARC/RARC code and routed to a coder who owns the appeal. We rebuild the claim with the documentation the payer is actually asking for, not a generic reconsideration letter. Recovery rate on appealable ambulatory surgery centers denials averages above 60 percent.
A written 30-day diagnostic. Dollar figures against every finding. No obligation.