Billing surgery

mieie4444

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I was always told that when you bill for a surgery that you should code the most expensive to the least expensive. Is this the way we are to bill the insurance?

Thank you
Sharon:)
 

OCD_coder

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You enter your codes based on CPT hierarchy (RVU), this is because of the multiple procedure rule. You want your highest RVU CPT code 1st so that it pays at 100%, then preceding procedures will pay at 50%. Depending on your contract and payor it multiple procedures can pay even less, for example 25% after the 3rd or 5th procedure. In some cases/payor, there is a cap on payment of no more than 7 procedures will be reimbursed. So it's very important to know your contracts and how each payor will pay their multiple procedure rules. Add-on codes typically are not subject to he multiple discount rule.

I hope that helps clarify for you.
 
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