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Sequencing of CPT affect REIMBURSEMENT?

  1. Post Sequencing of CPT affect REIMBURSEMENT?
    Medical Coding Books
    Does sequencing of CPT coding affect REIMBURSEMENT! I’m coding physician’s facility and non-facility. What or where can I get something in writing?
    “I know for audit purposes sequencing will be a issue.”

    Everyone, please give me your opinion.

    Thank you,
    CPC, I wondering now!
    Last edited by ciwil123; 01-24-2011 at 12:08 PM. Reason: title

  2. #2
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    Sequencing is huge when it comes to reimbursement. You need to code the highest RVU first and then sequentially. Reimbursement goes down per sequenced procedure that is why you code the highest first. You receive 100% and then 50% and so forth...
    Ali Coleman ~ CFE, CPC, CEMC
    Defense Health Agency
    TRICARE/Department of Defense
    Health Care Fraud Specialist

  3. #3
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    North Carolina
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    Quote Originally Posted by ciwil123 View Post
    Does sequencing of CPT coding affect REIMBURSEMENT! I’m coding physician’s facility and non-facility. What or where can I get something in writing?
    “I know for audit purposes sequencing will be a issue.”

    Everyone, please give me your opinion.

    Thank you,
    CPC, I wondering now!
    6. Rank the surgeries subject to the standard multiple surgery rules (indicator “1”) in descending order by the Medicare fee schedule amount;

    7. Base payment for each ranked procedure on the lower of the billed amount, or:

    • 100 percent of the fee schedule amount (Field 34 or 35) for the highest valued procedure;
    • 50 percent of the fee schedule amount for the second highest valued procedure; and
    • 25 percent of the fee schedule amount for the third through the fifth highest valued procedures;

    Starts on page 110

    https://www.cms.gov/manuals/downloads/clm104c12.pdf

  4. #4
    Default Sequencing
    Sequencing does matter for reimbursement - if you're not paid by RVUs then consider listing the codes in order of importance. Insurance companies won't rearrange the order billed to give you the highest payment.

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