Wiki Surgical center facility charge

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csammon24

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A patient had a paravertebral facet joint cervical injection on C4/5. The surgical center charged the facility fee twice and then charged paravertebral facet joint cervical injection 2nd level facility fee twice. Is this correct? All these services were done on the same date.

10/18/2021 Paravertebral facet joint cervical injection $5061
10/18/2021 Paravertebral facet joint cervical injection $5061
10/18/2021 Paravertebral facet joint cervical injection 2nd level $3796
10/18/2021 Paravertebral facet joint cervical injection 2nd level $3796

Does anyone have any experience with this? Does the surgical center get to charge for each procedure even though they were all done on the same day?

Any help would be appreciated!
 
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csammon24 said:
A patient had a paravertebral facet joint cervical injection on C4/5. The surgical center charged the facility fee twice and then charged paravertebral facet joint cervical injection 2nd level facility fee twice. Is this correct? All these services were done on the same date.

10/18/2021 Paravertebral facet joint cervical injection $5061
10/18/2021 Paravertebral facet joint cervical injection $5061
10/18/2021 Paravertebral facet joint cervical injection 2nd level $3796
10/18/2021 Paravertebral facet joint cervical injection 2nd level $3796

Does anyone have any experience with this? Does the surgical center get to charge for each procedure even though they were all done on the same day?

Any help would be appreciated!
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The codes are unilateral, it looks like they charged once for right side injection and once for left side. The same seems true for second level injections.
 
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Is it normal for a surgical center to charge for all procedures done even though they were done at the same time? Or is there a discount that is taken due to multiple procedures?
 
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It depends on who you are billing. Medicare will pay 100% the first code, 50% the second and so on. BCBS of MI for example (where I code) will pay 125% the first line and $0 pay the rest. But to accurately reflect what was done, all of those codes would be used if the doctor injected two levels both left and right.
 
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Yes, the doctor injected 2 levels. But this is not the doctors charges. This is what the surgical center is charging for 2 levels and bilaterally. It seems like it's a little excessive for the surgical center to charge for the same procedures the doctor would even though they were all done at the same time. So is the surgical center charging appropriately?
 
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csammon24 said:
Yes, the doctor injected 2 levels. But this is not the doctors charges. This is what the surgical center is charging for 2 levels and bilaterally. It seems like it's a little excessive for the surgical center to charge for the same procedures the doctor would even though they were all done at the same time. So is the surgical center charging appropriately?
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If it's two levels and bilateral, then the coding looks correct. So the charges appear to be correct, but as to whether or not they're appropriate, there's really no way to answer that as that is somewhat subjective. Facilities can charge pretty much whatever they choose to - there's very little in the way of regulation for this. But the fact of the matter is that the amount charged has little relevance because insurance companies will pay according to what their fee schedules determine, not according to how much is charged. Unless the patient is self-pay and is going to be responsible for the entire bill, the facility will ultimately accept a lower amount as payment in full for the procedure according to the terms of their contracts with the payers.
 
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