Wiki Order of procedure codes on claims

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chamilton122883

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Good morning,

Every biller in my office, myself included, seem to have been told at one point or another that the order of the CPT's on a HCFA must be in the order of the most expensive line item to the least. This sometimes creates issues with our specific billing software when changing the order, so if we could avoid this it would be great. Can anyone tell me if there is a reason for billing line items in order of charge amount? I have looked all over the internet and cannot find anything stating the order makes a difference either way.

Thanks!
Casey
 
That is how we have always done it, highest RVUs to lowest. The main reason I see is you want to be paid for your biggest ticket items first, if something is going to reject as bundled you would rather it be the lower cost item than the higher. So in theory, first code entered should be first code paid.

Just my opinion,

Laura, CPC, CEMC
 
I agree with Laura. Alot of carriers reimburse at 100% on Primary code, then 50% on 2nd, and some even go to 25% on 3rd & thereafter. That is the reason for the highest RVU codes listed down to lowest. The only scenario that this doesn't work is Spine Sx. When listing out the codes for a spine sx it is recommended to put the add-on codes directly after the initial codes regardless of price.

Jenna
 
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