Endoscopy rule and fees

dodo3000

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I have been told since learning endoscopy coding to reduce the fees for the 2nd, 3rd, etc. procedure that may have been done following the scope rules. So for example, provider did a 45380 and 45385. We would bill that as 45385 (full fee) and 45380-59 (fee of 45378 subtracted from 45380). I don't see anything on CMS.gov that states you have to reduce the fee before submitting the claim, just that they would process the claim payment based on those rules.

Does anyone else reduce their fees when billing EGDs or colonoscopies? If they don't, do you have any references that could be helpful in showing why you shouldn't do this?

Thanks!
 
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Let the payer reduce the reimbursement

Do not reduce your fees for 2d or 3rd procedures performed in the same session. Let the payer reduce their reimbursement and take your adjustment accordingly.


HOWEVER ... if you know in advance that a patient is self-pay, it is appropriate to apply the multiple procedure reduction at the time of invoicing the patient. Do NOT merely reduce the fee, but list the full fee and then the adjustment.
For example
Proc 1 - $ 2500
Proc 2 - $ 2300
Discount - $-1150

TOTAL DUE: $3650

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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