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Wiki Supplies in an office setting

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belindapearl

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Poplar Bluff, MO
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It has always been my understanding that you can not bill for supplies when a procedure is done in the office. We recently had an outside auditor tell us that this is not so. I read the guidelins in cpt book and it states Supplies and materials provided by the physician over and above those usually included with the procedure rendered are reported separately. Now I am confused. Our doctors now want to bill for gauze, and everything else. I always assumed that supplies over and above was meaning surgical trays, etc...

Any thoughts?
 
I would ask your outside auditor to show you "proof" of where it states you can. As you noted, the CPT book specifically addresses this and it would be interesting to see where they are coming up with their information.
 
I believe the medical supplies they are talking about are things like ace bandages or a wrist brace ect. These are supplies that can be purchase in a store, therefore you can bill the patient not the ins co....
 
I've researched this issue extensively and CPT defines the appropriate coding pretty well. The reimbursement will vary by carrier.

For 99070, CPT states ... Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided). The key words in the statement are over and above those usually included with the office visit or other services . When the relative value (RVU) is assigned, it includes the value for supplies usually provided in an office setting. For example. laceration repairs are often done in an office setting and the supplies are included in the RVU for the repair performed in an office setting.

99070 should be billed in an office setting when the service would not usually be performed in an office setting.

An example I experienced was a newborn was brought into the clinic for a circumcision. Because this is not something that is usually done in an office setting, the supplies are separately billable.

Now, for the reimbursement. CPT Code 99070 has a B status indicator for Medicare, so don't count on reimbursement from Medicare. Check with commercial carriers for their reimbursement policy. I hope this is helpful.
 
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