Wiki Dermatology Billing Question - Multiple Procedure Reduction

[rdavis@rpmmedicalbilling.com]

I have a Mohs Surgeon that is bringing in a Facial Plastic Surgeon to complete all of the closures on his Mohs cases. He is hoping to bill the plastic surgeon under his individual NPI so that the closure does not get his with the multiple procedure reduction. Has anyone ever seen this work?

thanks in advance!

 

[SharonCollachi]

"Under his NPI" meaning under the plastic surgeon's NPI? So two doctors that are not working under the same tax ID are going to do two different parts of the same procedure and try to each get paid for their part, and this procedure doesn't qualify for an assistant surgeon. So you're looking at co-surgeons. Is that the scenario?

 

[thomas7331]

Mohs procedures codes don't include a closure, so it doesn't need to be billed as a co-surgery claim - these are two distinct procedures and each provider will bill for their own work.

Since these are two different providers of two different specialties, then most payers would likely not apply a multiple procedure reduction, but if both providers are billing with the same tax ID there's a chance that some payers may process the claim at the practice level and may still reduce one procedure. If that's the case, I don't think you have any grounds on which to challenge the reductions since the two providers are sharing the same space and technical costs and performing the procedures during the same encounter.