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Facility pricing for multiple procedures

  1. #1
    Red face Facility pricing for multiple procedures
    Medical Coding Books
    I mainly do physician coding but also do facility for our ASC. I know modifier 51 is not to be used for facility billing so I've never been certain about half-pricing for multiple procedures. For example, patient had:

    1. Diagnostic laparoscopy with pictures. (49320)
    2. Chromopertubation of fallopian tubes. (58350)
    3. Hysteroscopy with pictures. (58558)
    4. Dilation and curettage of polyps from the uterus. (58558)

    Should 58558 be charged at the full price and the other two at 50% as it is on the physician side or does everything get charged at full price for facility?

    Thanks.
    Shannon, CPC, CCA

  2. #2
    Location
    Columbia, MO
    Posts
    12,531
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    whether physician or faciltiy billing, you should always charge based on your stated fee schedule and let the payer do the discounting. we list the procdures on the claim in RVU order highest to lowest. Just remember on your diagnostic lap and the chromopertubation, you cannot bill for the diagnostic lap once a definitive procedure is performed via the approach. and again you cannot charge twice for the 58558 as one is inclusive in the other. so you have 2 procedure codes for this encounter not 4. Discounting will occur in the facility for any status S procedures.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Default
    Thanks for your help.
    Shannon, CPC, CCA

  4. Default
    our facility is needing help with how to correctly bill out multiple procedures under revenue code 360 for the same encounter on a patient. Right now all items listed under rev code 360 rolls into one line item and will only pull the first cpt code listed input by the coder. We had found a way for this to split out into more than one line item and pull all the procedure codes. However the first line item has the total charges and the other line items show the cpt code with a $0 charge. Our billers are stating they have to delete these line items with $0. But then our claim is not showing all the procedures that were performed. This is for the facility side.
    How are other facilities doing this?

  5. #5
    Location
    Columbia, MO
    Posts
    12,531
    Default
    can you provide an example with codes?

    Debra A. Mitchell, MSPH, CPC-H

  6. Default
    yes say we have a patient who has a colonoscopy, an EGD, and maloney dilation
    so we have coded 45378, 43235, and 43450. On the UB for the facility charges it looks like this
    the total amount is all rolled under one line item on the UB
    REV CODe
    360 OR services 45378 $3,000 (total charges made up)

    or say another example a patient has a shoulder scope done such as 29827 (RC Repair), 29824 (claviculectomy), and 29826(subacromial decompression)
    and this is how it will look on the UB
    360 OR services 29827 (and the total charge)

    we were going to try this and got it to split
    360 OR services 29827 $5,000
    360 OR services 29824 $0
    360 OR services 29826 $0
    but the billers stated they had to delete all $0 charges

    I as the coder want every procedure that was done to be on the UB for the facility fee. To me then it looks like we are missing codes.
    Thank you for any suggestions or advice that you have

  7. #7
    Location
    Columbia, MO
    Posts
    12,531
    Default
    That is not how outpatient services should be billed. You have a problem with the chargemaster and until that is fixed there is nothing you will be able to do. You need to have a line item for each CPT code, you need to check your CCI edits for possible bundleing and in some cases you will use modifiers for some procedures. Generally you cannot submit $0 charge line items, but you would not want to do that anyway. You will be reimbursed the APC value for the CPT code and if the charge is less than the APC value then of course you will get less. In the facilites I have worked in for outpatient, everything but the 10000-69999 CPT codes were assigned thru the chargemaster by charge code and the 10000-69999 were assigned by the coders. The CPT code would cross to the chargemaster where the appropriate charge code and amount would append to the claim. You will need to have someone take this up with the person in charge of the chargemaster for your facility and learn how it works and help fix it.

    Debra A. Mitchell, MSPH, CPC-H

  8. Default
    Thank you for your feedback and I completely agree with what you are saying. I want this fixed more than anything that is why I am trying to get back up from other facilities on how they are doing this. Again appreciate your feedback.

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