Wiki Novasure Ablation Reimbursement

[karey]

Does anyone know how to get the maximum reimbursment for a Novasure Ablation. I code 58353 for Endometrial ablation w/o hysteroscopy & I use 58563 for endometrial ablation w/ hysteroscopy. The ablation w/ the hysteroscopy is the one that is more expensive and we are only getting reimbursed $300-$400. That's not even half of what we bill for the procedure! Please help!

Karey,CPC

 

[amjordan]

First are these being done in office or at a facility? Normally, facility reimbursement is lower because you don't have the same overhead that you do in the office. As an example, I have provided our Medicare reimbursement for these codes below. As you can see, the reimbursement for the procedure in a facility (Hospital, Surgicenter) is less then the non-facility (Office). So you need to consider where you are doing the procedure and check to see if your place of service code it correct on your claims.

Non-Facility 58353 $1024.82
Facility 58353 $209.89

Non-Facility 58563 $1669.68
Facility 58563 $332.61

You also need to take a look at the fee schedules for all of your insurance contracts and see if they include facility and non-facility reimbursement as well.

Angela Jordan, CPC
Manager Coding & Compliance
Women's Healthcare Network, LLC