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Billing for an ov and a non covered procedure


Tulsa, OK
Best answers
I've searched the forums and cannot find a thread covering this issue, so hopefully I am not duplicating a subject that's already been discussed.

In some instances our physicians do both an office visit and a procedure, knowing in advance that the procedure is non covered by insurance and billable to the patient after denial. The physicians prefer not to have to bill the patients for this procedure. Is it legal for them to bill only for the office visit?

I've always been taught that you code for the services that were rendered in all cases except where CCI edit precludes that.

Any feedback would be appreciated, especially if you can point me to anywhere that it is documented as to the requirements.

Thanks in advance,

Cate Butsko, CPC

O.S.U Physicians
Department of Surgery
(918) 584-5812
(918) 747-7604
Milwaukee WI
Best answers
You must treat all patient equally

You must treat all patients equally. Physicians should document the services they perform. Coders should code/bill out the services documented.

If there are patients with financial hardship, you should have a protocol in place for the practice to help identify those patients and make payment arrangements and/or discounts.

Hope that helps.

F Tessa Bartels, CPC, CEMC