Wiki Serious Question regarding changing fees

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SummerCTierno

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Hi everyone! I just began working in a coding office that is attached to a hospital. I am coding mostly the physician's offices that are also owned by the hospital. Recently a co-worked asked me to helped her code a pain clinic. She was showing me how to code the clinic, and for pain injections into each hip, she wants me to code, for example:

20610 1.0 1.70 Drain/Inject Joint/Bursa major joint ($300)
J1030 2.0 Inj Methylprdnisolone Act (40mg)

and change the 20610 to $600 and add modifier -50 (meaning they would get $1200 for this)

To confuse me more, she only wants me to do this for one doctor out of three in the same clinic. When I questioned her, she said this is how we have to do it to get paid, and when I tried to ask more questions, she actually yelled at me.

Am I overanalyzing this? Is this common practice? I just want to understand why I am coding something in a certain way because I want to be coding correctly.

Thanks everyone!
 
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Confused? The 51 modifier will not double the reimbursement, did they perform two injections ? Were there any other codes on the claim? And what is the 1.0 1.70 ? If they did both hips it would be a 50 modifier and you do not double the charge and they will not double the reimbursement the best you get is 150% of the negotiated fee schedule.
 
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It's always good to understand the coding process. I'm sorry your co-worker got defensive with you. She/he may not understand and didn't want to lose face.

If you have a supervisor, I would ask to make sure I was doing it correctly. I'm not sure why this would only apply to a single doctor, but I would be curious to find out.

For bilateral injections, we add modifier 50 and our billing software automatically adjusts the price according to rules we've set up. In the case of 20610-50, the price get's adjusted to 150% of the fee.
 
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yes

That is how I understood it to properly work - with adding the modifier, etc., so I am completely uncomfortable changing these fees. When I spoke to the supervisor, she said this is "common practice." ???
 
Actually it is not common practice, you should look at then policy per your contracts. Most payer require bilateral to be billed as a 50 modifier with one unit and the single code price per your stated fee schedule. When you signed on with that particular payer your office negotiated a contract for services, this was based on your stated fee schedule. You are suppose to bill your services according to this stated fee schedule. Just because you change the fee on the claim does not mean you will be paid higher unless the contract is for percentage of charge. If that one doctor has a different contract than the rest and that is the fee schedule it is based on that is one thing, but it needs to be explained that way. The 50 modifier communicates that the fee is to be increased 150%. Some carriers policy is to bill bilateral services as 2 line items using the RT and LT modifiers. It just depends on the carrier.
 
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