CPT 58558 and 58563

[sharper0125]

Can 58558 and 58563 be billed together, they both were done on the same day, by the same provider?

 

[csperoni]

58563 only

58558 & 58563 are CCI edits:
Code 58558 is a column 2 code for 58563, These codes cannot be billed together in any circumstances.
Code 58558 is bundled into code 58563 Code 58558 cannot be billed with 58563.
CCI edit Rule:More extensive procedure
You would bill for 58563 only.

 

[sharper0125]

Thank you

 

[amyjpaine]

I hope it is ok to add to this question...In the situation mentioned by the original poster, would you still bill 58563 if a particular payer reimburses 58558 at a higher rate than 58563?

 

[csperoni]

NO!! Code decisions are based on what was actually performed (and the documentation of such). You should never assign inaccurate codes in order to get a higher reimbursement. Such practice is abuse & potentially fraud.

Here is the CMS fraud definition:
In general, fraud is defined as making false statements or representations of material facts to obtain some benefit or payment for which no entitlement would otherwise exist. These acts may be committed either for the person’s own benefit or for the benefit of some other party. In other words, fraud includes the obtaining of something of value through misrepresentation or concealment of material facts.

Intentional incorrect coding is exactly that - a false statement or representation to obtain payment.