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sequencing charges

  1. Default sequencing charges
    Medical Coding Books
    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?


  2. #2
    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 !!!!
    Amy Pritchett,
    2017-2018 Secretary of Local Mobile AAPC Chapter
    2015-2016 President of Local Mobile AAPC Chapter

  3. Default 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.


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