Wiki Is sequencing CPT codes by highest to lowest RVU still necessary?

Create Wiki Sort by votes
M

milleap

New
Messages
4
Location
Nicktown, PA
Best answers
0
This is particularly for ASC claims as our new EHR isn't currently sequencing by highest to lowest and our ASC billers are stating it has to be fixed. My understanding is many payers resequence in their software, but I'm not an expert on 1500 billing or ASC claims.
 
0
I have been in claims billing and payment for about twenty years, working for professional and facility providers and for a couple of different payers as well, and in all that time have never once come across any issue with sequencing of CPT/HCPCS codes on a claim in a particular order. I believe that is a very old requirement and I don't know of anyone who still follows that. I suppose there may be an odd payer or provider that has an antiquated system somewhere that still requires it, but I think the newer technologies have all but eliminated the need to do this any more. Unless your ASC is getting denials, rejections, or incorrect payments, then it is not something that 'has to be fixed'.

I'd just add too that RVUs apply to professional reimbursement only - ASCs are not paid based on RVUs and the relative value concept doesn't even apply to facilities, so I don't know why the ASC billers would think that this is important.
 
0
By "ASC billers" do you mean billing for the doctors that go to the ASC, or billing for the facility itself?

If for the doctors, I still sequence my CPT codes. Otherwise, how can you get the modifiers on the correct codes? As well, it helps me make sure I've captured everything. For instance, patient comes in for his monthly pain management visit. While here, doctor decides he is going to give a pain shot because the patient fell down yesterday. Sequence:

1. Office visit with 25 modifier.
2. Pain shot delivery 96372
3. Injectables used in pain shot.

Or if he is doing two separate procedures, and I need to put a modifier on one to show it is separate.
 
0
SharonCollachi said:
By "ASC billers" do you mean billing for the doctors that go to the ASC, or billing for the facility itself?

If for the doctors, I still sequence my CPT codes. Otherwise, how can you get the modifiers on the correct codes? As well, it helps me make sure I've captured everything. For instance, patient comes in for his monthly pain management visit. While here, doctor decides he is going to give a pain shot because the patient fell down yesterday. Sequence:

1. Office visit with 25 modifier.
2. Pain shot delivery 96372
3. Injectables used in pain shot.

Or if he is doing two separate procedures, and I need to put a modifier on one to show it is separate.
Click to expand...
It's the ASC claim which would have at times a couple procedures.
 
You must log in or register to reply here.
Top