Wiki Same DOS but separate procedures

SA91

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Hi everyone,

Please can someone advise?

I have two procedures which took place on the same DOS but these procedures were performed on two different anatomical sites (this billing for an ASC outpatient). One procedure was for an Knee Joint Injection 20610 and the other LMBB Bilateral (64493-64495). I would think that these two procedures should be on separate claim forms (separate case number) but I could be wrong that is why I just want someone to advise me on this?

I would appreciate any help!

Thank you!
Lisa.
 
If the two procedures were both performed during the same encounter - i.e. the patient did not leave the facility and return at a later time that day - then both should be billed on the same claim form.
 
If the two procedures were both performed during the same encounter - i.e. the patient did not leave the facility and return at a later time that day - then both should be billed on the same claim form.
Hi Thomas,

Thank you so much for your help! I have listed the Primary Code to be the 20610 would you agree that this is appropriate or should it be the LMBB listed as the primary?
 
What do you mean by 'listed the Primary Code'? Do you mean it's the first sequenced code on the claim? If so, it really doesn't matter what order the codes are listed - payers will calculate the correct reimbursement based on the entire claim, not on the order of the codes.
 
What do you mean by 'listed the Primary Code'? Do you mean it's the first sequenced code on the claim? If so, it really doesn't matter what order the codes are listed - payers will calculate the correct reimbursement based on the entire claim, not on the order of the codes.
Yes the first sequenced I realized my wording was not correct on this I apologize! I appreciate your help thank you :)
 
So here's the thing... there are some payers that will bundle a more expensive procedure into a less expensive procedure. For instance, if we do a major joint injection and trigger point injections at the same session, there are some that will only pay the trigger point injection if that is listed at all, and some that will only pay whichever procedure is listed first. No amount of fighting this has ever gotten me anywhere. So the choices are to perform them at separate sessions, or only bill the more expensive procedure, to those insurances.

So just something to be aware of.
 
So here's the thing... there are some payers that will bundle a more expensive procedure into a less expensive procedure. For instance, if we do a major joint injection and trigger point injections at the same session, there are some that will only pay the trigger point injection if that is listed at all, and some that will only pay whichever procedure is listed first. No amount of fighting this has ever gotten me anywhere. So the choices are to perform them at separate sessions, or only bill the more expensive procedure, to those insurances.

So just something to be aware of.
I bill both together and use the XS (separate structure) modifier (and then laterality modifier) on the facet injections, because they are a column two code to the 20610. I rarely have denials for bundled, and then usually just sending records get them reprocessed and paid.
 
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