Wiki Billing 2 surgeries

Kim M Gordon

Best answers
This is a discussion in our office, the patient has 2 surgeries, (ex. a bladder incision and ureter repair) and one code is not built in to the system, and can not be at this point because of the date of service, they are saying that certain payors will allow you to bill the one code and you don't need to send in the other code, I am sure they as it will save them money, but can someone help me find the guidelines to prove this is incorrect coding ethic.....

thanks :

Your question is confusing.

Are you saying that you have a CCI edit that does not allow you to code one of the procedures?

Are you saying that you need an unlisted code?

For an accurate response to surgical coding questions, please post the scrubbed operative note. Additionally, you will attact the specialty coders with the most experience by posting your question in the most appropriate specialty forum.

Sorry I can't be more helpful than that.

F Tessa Bartels, CPC, CEMC
I think what you are describing is a billing system limitation, the system will not allow you to input a certain code for whatever reason, is this correct?

I'm not really sure what type of guidelines you are looking for to support billing for all services that were provided.

If you can support the service was done, you assign all supported codes, run these codes past any payer edits (i.e. CCI), and then bill out the appropriate codes based on the requirements that apply to that particular case. To do anything else would be wrong. You would either be under coding which can be viewed as enticement, over coding, or unbundling and all of these fall under either the abuse or fraud heading.

I hope that was helpful,

This is the scenerio, we did a bladder incision and a ureter repair, because the bladder incision cpt code was not built in the billing module with the effective date being prior to the surgery, the billing deptartmen said it is "okay to only bill a partial surgery because they do not want to go back and change an effective date" . I have never heard of any "guidelines" that say its okay to only part of a code and bill to the fullest extent of the surgical procedure. I hope this is more clear. Sorry about that.