Listing codes by RVU--expert advice?

CatLaw

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I have a question about listing codes according to RVU. Any advice, opinions are appreciated. And expert advice greatly appreciated!! I have always been told that you should list your codes on the claim from highest RVU to the lowest and have always done it that way. My employer does not believe it makes any difference. But what is happening is when I and our other coder are listing our codes per highest to lowest and bill them out, our billing system takes our order and flips the codes because the RVU's in our billing system are set up wrong. The RVU on code 29826 has gone down significantly this year and our employer will not change it. So now the code is listed as primary when going out on the claim when it is in fact listed as the last code we listed (with 29827, 29824 and 29823). In another situation, I sometimes bill codes 25447 and 26480 together, with a modifier on the 26480. Our system is set up with 26480 with the higher RVU (when in fact 25447 has a higher RVU) so again, I bill it out, the system flips the codes. And 26480 is primary with a modifier. I just don't think this is right. I have found articles that says you are setting yourself up for a potential reimbursement issue and may be getting paid less than you should be paid. We have approached our employer about it and they completely ignore anything we have brought to their attention. We also had a strange code message on a payment we received that basically told us to be aware of billing guidelines. Anyone have any advice on this? Thank you!
 

RebeccaWoodward*

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I agree with you. I also post according to RVU order. You could be at risk at losing proper reimbursement.

6. Rank the surgeries subject to the standard multiple surgery rules (indicator “1”) in descending order by the Medicare fee schedule amount;

7. Base payment for each ranked procedure on the lower of the billed amount, or:
100 percent of the fee schedule amount (Field 34 or 35) for the highest valued procedure; 50 percent of the fee schedule amount for the second highest valued procedure; and 25 percent of the fee schedule amount for the third through the fifth highest valued procedures;


http://www.cms.gov/manuals/downloads/clm104c12.pdf

Page 110
 

CatLaw

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They won't allow us to change anything in the system. I wish I could. This just bothers me so much. They are afraid to inflate their fees...that is what they are telling us why they won't correct the issue. We keep telling them it will not cause any inflation..it is just to correct the issue. I honestly believe it is because they truly don't know what they are doing. They have the wrong people doing the job.
 
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