Wiki sequencing charges

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boozaarn

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If I need to bill for EGD and colonoscopy - same day
Does it make any difference what cpt is first listed?
Is the high value first is a mast or a convention?

Thanks
Boozaarn
 
First of all, are you in a physician office or are you OP Surgery or ASC? This matters tremendously in all three sectors.
If physician, the insurance company will pay the first listed procedure and if the EGD is less than the colonoscopy, they will pay the EGD first and then you will not be reimbursed for the full price of the colonoscopy.

If in an OP or ASC, the sequencing matters because, the APC rates are different on an EGD and Colonoscopy.

I would place the colonoscopy primary (first listed CPT) and then EGD (second listed) with the addition of a -59 modifier. This will let the insurance know that this was a totally identifiable separate procedure and will not take the multiple reduction for multiple procedures.

Hope this helps !!!!
 
Thank you

It's an OP facility. Could you bring an example with the APCs and how the charge order makes the difference in payments.

Boozaarn
 
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