Wiki Operating Room Services Billing question

[BarbaraBate2023]

I am reviewing a bill from a hospital where a 24-hour stay occurred. The person had a laparoscopic hysterectomy (ob/gyn) and CMC joint arthroplasty w/tendon transfer (by ortho) on the same day in the same OR setting (The patient was not woken from anesthesia). I have been asked to cull our charges specific to the CMC joint arthroplasty and the tendon transfer. The hospital billed "OR Services" for each CPT code (58571 for hysterectomy, 25447-LT and 25310 for CMC/tendon transfer) without a modifier (the full charge for each). Is that allowable or should they have added the 51 modifier to CPT 25310? Both hand/wrist procedures were done by the same surgeon, same day, say surgical site. Thanks in advance.

 

[thomas7331]

Modifier 51 is not normally used in hospital outpatient coding. Unless a specific payer requires it, a modifier 51 is informational only and would have no impact on payment.

 

[BarbaraBate2023]

Modifier 51 is not normally used in hospital outpatient coding. Unless a specific payer requires it, a modifier 51 is informational only and would have no impact on payment.

Thank you very much. It seems like double-dipping in a sense since the time and supplies in the OR would be less if the procedures were done in the same setting v. doing them separately. Nevertheless, thank you.

 

[thomas7331]

Thank you very much. It seems like double-dipping in a sense since the time and supplies in the OR would be less if the procedures were done in the same setting v. doing them separately. Nevertheless, thank you.

You're correct in that it inflates the hospital's charges if they do not adjust down the amount billed for a multiple procedures or adjust for the overlapping OR time or supplies. But then again, adding a modifier wouldn't solve that problem as it wouldn't change what was charged. But modifier or not, payers will apply their multiple procedure reductions in calculating the hospital's payment so the inflated charges shouldn't make a difference in the end.