tmgexp1@yahoo.com
Networker
An orthopedic surgeon admits a patient on 7-12-13 for a planned knee arthroplasty. Does the arthroplasty on same day. Can he bill for the admit (99222) and the arthroplasty?
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Wiki please clarify
- Thread starter tmgexp1@yahoo.com
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please clarify-Orthopedic arthroplasty procedure
If Dr is admitting the patient as an outpatient, then you charge for the procedure only. The fee normally includes for his time spent in the Operating Room performing the arthroplasty and for a certain amount of post operative visits. If you're not sure, the best thing to do would be to clarify with the Office Mgr or Dr, himself as to whether there is a medical reason the patient would be admitted as an early morning admission, (EMA) and perhaps stay until the next day. These patients are also treated and billed by the Hospital as out-patient or 23 hr stay patients. Your best bet is, "When in doubt, check it out." as you are doing now. As an in-patient the charges would be slightly different.
Special Note** You need to know what the office policy is for your Drs. Even for admitting these patients into the hospital. Many surgeons will charge for in-patients for the surgical fee only since their fee is a higher charge and the Standard of Practice is: if Dr performs multiple procedures on a patient in the same area of the body, then the most technical fee is charged for. You maynot bill for multiple procedures when surgery is performed on the same area of the body. (Refer to your CPT coding book-2013.) i.e. MVA, possible Fx'd Right tibial neck fx. Surg.procedure: Rt hip arthroscopy, Open reduction of femoral neck fx with internal fixation. (27236) In this case, you would charge for the ORIF of the femur with internal fixation. Also coding the MVA or auto accident code.E-code. I hope this information helps you.
H.Strasko, RN,CLNC, CPC-A
If Dr is admitting the patient as an outpatient, then you charge for the procedure only. The fee normally includes for his time spent in the Operating Room performing the arthroplasty and for a certain amount of post operative visits. If you're not sure, the best thing to do would be to clarify with the Office Mgr or Dr, himself as to whether there is a medical reason the patient would be admitted as an early morning admission, (EMA) and perhaps stay until the next day. These patients are also treated and billed by the Hospital as out-patient or 23 hr stay patients. Your best bet is, "When in doubt, check it out." as you are doing now. As an in-patient the charges would be slightly different.
Special Note** You need to know what the office policy is for your Drs. Even for admitting these patients into the hospital. Many surgeons will charge for in-patients for the surgical fee only since their fee is a higher charge and the Standard of Practice is: if Dr performs multiple procedures on a patient in the same area of the body, then the most technical fee is charged for. You maynot bill for multiple procedures when surgery is performed on the same area of the body. (Refer to your CPT coding book-2013.) i.e. MVA, possible Fx'd Right tibial neck fx. Surg.procedure: Rt hip arthroscopy, Open reduction of femoral neck fx with internal fixation. (27236) In this case, you would charge for the ORIF of the femur with internal fixation. Also coding the MVA or auto accident code.E-code. I hope this information helps you.
H.Strasko, RN,CLNC, CPC-A
mhstrauss
True Blue
Was the surgery pre-planned/elective? If yes, the MD has already evaluated the patient. The "admit" paperwork that I think you are asking about (usually considered a History & Physical) is included in the global surgery charges. It is generally a facility requirement, and not separately billable.
If the MD has not previously evaluated the patient (for example, pt came in through ER for trauma), and this "admit" is where the decision for surgery is made, then the admit is separately billable, with modifier 57 (Decision for Surgery).
Hope this helps!