AAPC - Back to school
Results 1 to 3 of 3

Thread: sequencing of CPT coding

  1. #1

    Question sequencing of CPT coding

    AAPC: Back to School
    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,

  2. #2
    Join Date
    Apr 2007
    North Carolina


    Is this what you're looking for?

    Page 108-

    C. Carrier Claims Processing System Requirements

    10. Rank the surgeries subject to the multiple surgery rules (indicator “2”) in descending order by the Medicare fee schedule amount;

    11. Base payment for each ranked procedure (indicator “2”) on the lower of the billed amount:
    • 100 percent of the fee schedule amount (Field 34 or 35) for the highest valued procedure; and
    • 50 percent of the fee schedule amount for the second through the fifth highest valued procedures; or

    12. If more than five procedures with an indicator of “2” are billed, pay for the first five according to the rules listed in 9, 10, and 11 above and suspend the sixth and subsequent procedures for manual review and payment, if appropriate, “by report.” Payment determined on a “by report” basis for these codes should never be lower than 50 percent of the full payment amount. Pay by the unit for services that are already reduced (e.g., 17003). Pay for 17340 only once per session, regardless of how many lesions were destroyed;

    NOTE: For dates of service prior to January 1, 1995, the multiple surgery indicator of “2” indicated that special dermatology rules applied. The payment rules for these codes have not changed. The rules were expanded, however, to all codes that previously had a multiple surgery indicator of “1.” For dates of service prior to January 1, 1995, if a dermatological procedure with an indicator of “2” was billed with the “-51” modifier with other procedures that are not dermatological procedures (procedures with an indicator of “1” in Field 21), the standard multiple surgery rules applied. Pay no less than 50 percent for the dermatological procedures with an indicator of “2.” See §§40.6.C.6-8 for required actions.

    13. If Field 21 contains an indicator of “3,” and multiple endoscopies are billed, the special rules for multiple endoscopic procedures apply. Pay the full value of the highest valued endoscopy, plus the difference between the next highest and the base endoscopy. Access Field 31A of the MFSDB to determine the base endoscopy.


  3. #3

    Talking Thanks for the resource

    Thank you for the answer to some of my question, here is a example:


    1-14-11 46824
    1-14-11 99232-25
    1-15-11 99232

    Or post

    99232-25 E/M First

    The way you enter the charges on your CMS-1500 does it really matter to remibursement? or do the Medicare/insurance companies pay any charges they wish at 100% of the higest RVU. for the first DOS.

    Another example

    office visit 99 code, with labs 8000 codes, and x-ray 70000. What is the proper way of sequencing? E/M first then highest RVU? or E/M first then all 8000 codes, then 70000 codes. I need some clairfication, please advise!

    Thank you,
    But, Getting Better!

Similar Threads

  1. CPT code sequencing
    By scaruthers13 in forum General Surgery
    Replies: 1
    Last Post: 06-06-2014, 02:15 PM
  2. Sequencing of CPT affect REIMBURSEMENT?
    By ciwil123 in forum Billing/Reimbursement
    Replies: 3
    Last Post: 06-06-2011, 10:36 AM
  3. sequencing of CPT coding affect REIMBURSEMENT!
    By ciwil123 in forum Medical Coding General Discussion
    Replies: 3
    Last Post: 01-24-2011, 07:41 AM
  4. Help with coding/sequencing
    By fritzta in forum Diagnosis Coding
    Replies: 4
    Last Post: 08-03-2009, 04:33 PM
  5. CPT Sequencing
    By TYBEN2 in forum Medical Coding General Discussion
    Replies: 4
    Last Post: 12-10-2008, 02:11 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.