"Separate Procedure" distinction

jdrueppel

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Does anyone have any insight or advise on "separate procedure" distinction codes. For example, a surgeon performs an inguinal hernia (49505) but also performs excision spermatic cord lipoma (55520). Because these are via the same incision the surgeon is billing for the highest surgically valued procedure 49505 but for anesthesia purposes 55520 has highest value.

I don't know if I'm overthinking this case but since it's a two unit differential I'd like other anesthesia coder's opinions. Do you feel it is appropriate to bill the 55520/00860 for the anesthesia service in keeping with the ASA Billing Guideline of reporting the code with the highest base unit value?

Thanks.
Julie Drueppel, CPC
 
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hgolfos

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Separate Procedures

Julie,

It is absolutely appropriate for you to bill the procedure with the highest base value regardless of how the surgeon is billing. The way that I think of it is that our docs are providing anesthesia for all of the procedures during the operating session, so any of them are billable from our standpoint. We should always choose the code with the highest base value in order to maximize our reimbursement. Additionally, when I have two different procedures with the same number of units I always choose the one for which I have the best diagnosis.

Hope this helps.

Heather G. CPC
 

LGillstrom

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Heather,

A great way to explain something that seems at face value to go directly against the grain of not "coding for dollars"!

And Julie,

Heather hit the nail on the head!
 
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