General Surgery Coding Alert

The HCFA 2001 fee schedule contains not only information you might expect, such as the number of relative value units (RVUs) assigned to particular procedures or services, but also additional information that can help general surgeons and their coders with coding decisions.

Most people dont realize the HCFA fee schedule can tell you whether you can bill for supplies, or if a procedure allows co-surgery, says Susan Callaway, CPC, CCS-P, an independent coding and reimbursement specialist and educator in North Augusta, S.C. But the fee schedule contains this information and much more, she notes.

The January General Surgery Coding Alert explained how to download and use the 2001 schedule. This final installment will reveal additional information that can be found in the fee schedule, including the level of physician supervision required for a procedure, if multiple surgery guidelines apply, the base endoscopic code for multiple endoscopic procedures, which supplies used to perform a particular procedure can be separately billed, whether modifier -50 (bilateral procedure) can be appended to a service, and whether a co-surgeon or assistant surgeon can be reimbursed for a particular procedure.

Multiple Procedures and Multiple Endoscopies

Column V of the fee schedule indicates how a procedure should be paid if it is not the primary procedure performed during the operative session. Most surgical procedures will have an indicator of 2, designating that the standard multiple procedure payment rule (100 percent for the highest-paying procedure, 50 percent for all the others) applies. (See sample fee schedule included with this issue). Diagnostic tests, such as x-rays, usually include an indicator of 0, meaning that no payment adjustment is made and the service is paid at 100 percent, even if it was performed at the same time as another service. If a procedure has a 1 indicator, it should be paid using the multiple procedure rule in effect before January 1995, which stipulated that procedures were paid at 100 percent/50 percent/25 percent/25 percent, etc. A 9 indicator means that the concept of multiple surgery does not apply.

Endoscopic procedures with a 3 in column V are subject to the multiple endoscopy rule. For example, in the included sample schedule, the endoscopic base code for 45382 (colonoscopy, flexible, proximal to splenic flexure; with control of bleeding, any method) is 45378 (colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen[s] by brushing or washing, with or without colon decompression [separate procedure]). The 3 in column V indicates that 45382 is subject to the multiple endoscopy rule and has an endoscopic base code.

The endoscopic base code is not included in column V, however. If column V contains a 3, coders should look to column AC, which [...]