Billing staff at ambulatory surgical centers (ASCs) need to be aware of the new Medicare N1 Codes resulting from the ASC payment system update that took effect on January 1, 2014. The Centers for Medicare and Medicaid Services (CMR) Change Request 8575 updates the Healthcare Common Procedure Coding System and makes changes to billing instructions and Medicare payment policies. The ASC payment system update only affects ambulatory surgical centers. In addition, these changes only affect billing of Medicare patients.

Change of Status for Procedure Codes

CMR has listed roughly 210 new procedure codes that have been given N1 status. Prior to 2014, the majority of these procedures were paid separately. As of 2014, these procedures will be grouped into covered surgical procedures and not paid separately.

“This will definitely have a big impact on Medicare patients,” Ladonna Schaad, CCS-P, CPC, abeo’s coding compliance manager, said. “Unfortunately, it’s getting harder and harder to obtain adequate reimbursement for services for Medicare patients.”

A list of the new codes can be found at the CMR website. The new changes are causing some confusion for billing staff who are unsure how to submit procedures for reimbursement. Currently, coders are divided between the following two approaches.

Omitting Medicare N1 Codes

Some coders are omitting N1 codes entirely when submitting to Medicare for reimbursement, figuring that since N1 codes are not paid separately from the procedure, they do not need to be submitted. The problem with this approach is that without submitting N1 codes, physicians will not be able to properly track the procedures a patient has undergone.

Submitting Medicare N1 Codes

The other approach some coders are taking is to submit the N1 codes to Medicare with a zero dollar charge, since payments for these procedures are not reimbursed separately from the surgical procedure. This approach solves the problem of physician tracking of procedures and compliance issues. The only issue is that some coders are getting coding errors when submitting the new N1 codes.

What Medicare Wants

Medicare is recommending that ASCs omit N1 codes and submit packaged services for reimbursement. With this approach for billing Medicare patients, ASCs will need to develop a new system for tracking N1 procedures for physician and demographic tracking. Currently, there is no standardized practice for handling these issues with the advent of CR 8575.

The Solution

abeo’s expert staff provides billing and coding services for ASCs and is up to date on the CR 8575 changes and new Medicare N1 codes. We can help your practice develop a system to properly bill Medicare and operate in coding compliance, ensuring fast reimbursement. We can also help practices develop a system of tracking Medicare N1 procedures for physician use and demographic data. Give us a call today to find out how we can help your ASC wade through the complex billing issues and coding procedures introduced with CR 8575.




abeo Management Corporation (abeo) serves as a leading source of revenue cycle management and practice management with a specialization in anesthesia. The company leverages its people, processes, and software to serve independent practices, surgery centers, hospitals and healthcare systems with a scope of services that include billing, coding, transcription, practice management, and business consulting.

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