Question Physician coding for outpatient procedure


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Can anyone give me suggestions for coding and billing this scenario. My patient has a procedure done in the office every month code 53855 (urethral stent change) . The physician performed a different procedure for another diagnosis/reason in the hospital as an outpatient (22) on this patient. At the same time she also performed the monthly procedure he usually has because he was due. However on the day of the procedure the hospital informed her they did not have the device (stent) available, so the provider took a device from the office stock. We are a private practice and are not owned or affiliated with the hospital other than surgical privileges. Payer reimbursement is based on code and site of service so how can I bill this and get reimbursed to cover and recoup the money we paid for the device we supplied. The payer Medicare will reimburse us at the facility par rate, so can anyone tell me how to bill for a device that should have been provided by the hospital?


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Since the reimbursement to the hospital for the procedure includes any devices that were used, the hospital would need to include that on their claim, and pay your provider as their supplier in the case. Your office will need to submit an invoice to the hospital to seek reimbursement for device. Or perhaps your provider could request that the hospital, once they have the item in stock again, replace the one that your provider used.

Your provider really should not do this. The hospital is responsible for all of the supplies, drugs and materials involved in the procedures that take place on their premises. Facilities have quality control measures in place for these, and liability insurance policies with guidelines that they must follow, and if there was a problem identified at a later date, or a recall of a device, they would need to be able to track that back to the patient. Outside parties should not simply bring in something they need for the procedure without going through the proper channels.