Multiple surgeries same day/billing Medicare patient

[mbsolutions]

I have a practice who scheduled a Medicare Patient to have two excisions same day... normally only one excision/day is done to avoid the multiple surgery discounts. Patient was advised by front office staff on the day he arrived that only 1 excision would be done, he would have to come back for the 2nd. He insisted he wanted both excisions same day (as he was scheduled for that) and was then advised by said staff member that if he wanted the 2nd excision, he would have to pay cash for it, and sign a waiver that he agreed that we would not be billing Medicare. Now the patient is angry and feels the office is ripping him and the Medicare system off, after all Medicare would cover this procedure. I am now involved to determine the Medicare rules on this. After exhausting the MDCR manuals... no luck finding any specific rule

Does anyone have any specific information that I can provide to the practice, so that corrective action, if necessary may be implemented. Thanks!!

 

[kvangoor]

I think you are ripping him off. If you are doing an excision in the same area as the first it should be paid at a discounted rate because the provider is already in the area and it is less work to do the second procedure. Also, why would your office schedule him for both excisions and then tell him he had to come back? Seems like your billing/coding and scheduling policys need to be reviewed.

 

[mbsolutions]

Thank you for your reply. I agree with you 100%, and have already started corrective action with the practice on this. I pretty much knew the answer, but was hoping for some solid information and Medicare Guidelines. I finally found the guidelines in the ABN, and Surgery billing guidelines. I was really surprised when I came across this while doing the billing audit, and new policies will be put in place.