Wiki 2 surgical services, 1 anesthesia service


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We have a plastic surgery patient who is having 2 different surgical services during one anesthesia session. The first surgical portion is breast reduction; the 2nd is abdominoplasty with pubic reduction. The breast reduction is a covered service with her insurance; the abdominoplasty is not. If these were done at 2 separate visits, we would bill the breast reduction to insurance and the other service as self pay. When 2 different types of surgical services are performed during one anesthesia session, I understand that we are to code the higher valued ASA code with total anesthesia time, right? Is it appropriate to bill the breast reduction with total anesthesia time included for both the breast reduction and the abdominoplasty to the insurance? The patient was not extubated, etc. for the 2nd service. Thanks!
I know for dental surgery, the commorbities the patient has that prevents the patient to have the procedure in an office setting or if the procedure is required due to cancer, procedure code 00170 is covered for Medicare and other carriers. But many carrier's have specific medical policies distinguishing between procedures that can be similiar techniques for comestic or treatment of condition. And they point out they only pay the particular procedure if not for comestic reasons. If you they don't cover the procedure for comestic reasons I would break out the anesthesia time for the comestic procedure and bill the patient and bill the other procedure time to the insurance company.
No, you absolutely cannot bill both or either one with the total anesthesia time. Your anesthesia record must clearly document when each procedure started and ended. You can only bill insurance for the procedure they should pay for and only the amount of time it took to do the procedure. If the abdominoplasty is cosmetic and the patient is paying for it I believe that would be "double dipping". Billing for cosmetic procedures done at the same time as covered procedures is very trickey and can cause you to get audited if you are not careful. Documentation of times and procedure start times and stop times is extremely important. Don't be surprised if the insurance company asks for notes. The billing rule regarding selecting the CPT with highest base units only applies when both procedures are covered by insurance. Always ,always only bill what is documented.
Good Luck.
Thanks - we did break it out and billed each service separately. The anesthesiologist did a great job of making sure the anesthesia record was very clear with the amount of time spent for each portion. And you're right, the insurance did request documentation, and we were reimbursed at our contracted rate for the breast portion. Documentation, documentation, documentation...