Wiki Coding questions for outpatient recovery room billing

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sande78705

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Rohnert Park, CA
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We normally don't bill insurance for our procedure room use and recovery time but the patient says her insurance will pay for it. We are also not contracted with her insurance. What type of code would I use for 1 hour use of our procedure room. We are using O2, EKG monitoring Iv fluids and medications with an anesthesiologist present. She was then sent to a room where it took about 2 hours for her to recover as she had no one to bring her home. Even though she was told that she needed to have that. She finally called an UBER. Any thoughts would be most helpful . This was all done in our office for an egg retrieval procedure. My MD is a reproductive endocrinologist.

Thanks
Suzanne
 
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Why don't you normally bill for the procedure? Is it part of a global fee for ovum retrieval? I bet you get nada from that insurance, if she even has the insurance. I'd be very suspicious of this patient.
 
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Are you accredited/licensed as a facility, or are you an office? Office don't bill for rooms/facilities.

Even if you were able to bill for a recovery room, the fact that she has no ride has nothing to do with what you bill/how much time you bill for (maybe rethink your policies about starting a procedure if the patient doesn't have a chaperone with her).
 
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I agree with Sharon. Likely your procedure room is considered part of your office (POS 11) and not Article 28, which basically can't be attached to an office. We used to have a AAAASF surgery suite in our office (POS 11) and when the RN went over items with the patient prior to the procedure, if she did not have someone with her, we would either wait until a chaperone arrived or reschedule (it only happened once or twice in several years).
From personal experience, my hubby was having a rotator cuff procedure in an Article 28 facility. At the time they were about to bring him in, I was in the hallway at the vending machine and they would not take him in until I returned to the waiting room.
My advice - I don't think there is anything you can do for this case that already took place. But you should have a policy regarding chaperones being present if your patients will undergo anesthesia.
 
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Thank you for your responses. The patient was well aware that she needed a chaperone and had told us that her son was coming prior to the start of her procedure. We are billing the patient for the time that was spent in addition to the extra supplies due to the fact we ended up using additional supplies. Our anesthesiologist was already on site and we couldn't post pone the procedure. This was an unusual case. And all this was done in our office procedure room Our patients are told prior to coming in that they must have some one to take them home. Also, We had to wait for her to actually wake up before we could send her out in the world. it is not so much that she didn't have a ride, but she wasn't
safe to leave. We are not billing insurance at all. This was a patient who had a self pay cost out and then decided that she wanted to bill her insurance. Once a patient receives a self pay cost out, we do not change in mid stream
 
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Good grief. What a mess. Didn't she have to pay anything up front before the procedure? When I worked in a plastic surgery group, if the procedure was expected to be self-pay, that meant pre-pay. She does have you over a barrel now though because the deed is done, she can refuse to pay, but I doubt the courts will let you withhold the specimen in lieu of payment. It's a sticky situation for sure.
 
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