The Medicare Claims Processing Manual is a comprehensive resource document published by CMS that contains definitions, policies, and processes relating to submitting a claim for procedures performed in an ASC.
Since October 1, 2015, Medicare has been using the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). According to the American Academy of Professional Coders (AAPC), ICD-10 is a standardized classification system of diagnosis codes that represent conditions and diseases, related health problems, signs and symptoms, external causes of injuries and diseases, and more. These codes are generally required by payers to justify procedures as medically necessary.
Payors, including Medicare, reimburse facilities such as ASCs separately from physicians. The facility reimbursement is called the “technical component,” whereas physicians are reimbursed via a payment called the “professional component.” The technical component is also called the facility fee and pays for services such as nursing, technicians, administrative services, etc.