Wiki Question on bill.

[cab5392]

Hello, unemployed coder here, and very rusty. Need urgent help with a personal situation. Just received an ER bill for an accident I had earlier this month. I would be correct that billing 12002 and 12001 x 2 for a small laceration on the middle finger, a small laceration on the pointer finger, and a small laceration on the thumb (all left hand) would be incorrect? Shouldn't they be combined into one code by the sum of the length of the lacerations, likely less than 7cm and fall under one iteration of the code 12002?


Thank you in advance! My financial situation is not great and a large error like this would be $1365 dollar mistake for me. I would like the input of a more experienced coder.

 

[sls314]

I'll answer with the caveat that it's hard to give a specific answer without seeing your chart and EOB.

In general, yes: repairs of the same anatomical area and of the same complexity would be summed and reported as one total length. There's a CCI edit for those codes together, which can be overridden with a modifier when the documentation supports it.

That being said, it's hard to be sure if that affected the dollar amount you're being billed though. An insurer is going to process the claim based on an allowed amount. Quite often an ER charge is paid based on a case rate or bundled rate based on the ER level that was billed.

In a situation like that, the line item charges wouldn't affect the overall bill. The E/M level for the ER visit is often the deciding factor in the allowed amount.

If you have additional information from your EOB, that might be helpful in seeing whether the insurer allowed additional reimbursement for those line items and whether it affected your total allowed amount.

Good luck!

 

[cab5392]

I'll answer with the caveat that it's hard to give a specific answer without seeing your chart and EOB.

In general, yes: repairs of the same anatomical area and of the same complexity would be summed and reported as one total length. There's a CCI edit for those codes together, which can be overridden with a modifier when the documentation supports it.

That being said, it's hard to be sure if that affected the dollar amount you're being billed though. An insurer is going to process the claim based on an allowed amount. Quite often an ER charge is paid based on a case rate or bundled rate based on the ER level that was billed.

In a situation like that, the line item charges wouldn't affect the overall bill. The E/M level for the ER visit is often the deciding factor in the allowed amount.

If you have additional information from your EOB, that might be helpful in seeing whether the insurer allowed additional reimbursement for those line items and whether it affected your total allowed amount.

Good luck!

Thank you! I am between jobs, uninsured, and am eating the entire cost. It is very important to me to make sure the bill is correct. I have the itemized bill here.

I am getting a server error trying to post image, one moment let me try to post on an image website. Screenshot-20

 

[amyjph]

I agree with Susan. It's very hard to tell without records. If you are looking at a facility bill (with revenue codes) it's the revenue codes and ED line that usually "matter". That said, they should still be correct codes in my opinion, even though it may not impact the final bill total. You would want to look at the professional fees on the ED provider bill too.

You are correct though, multiple wounds of the same complexity and same anatomic area are added together for one total size.