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cosmetic surgery and billing insurance

  1. #1
    Default cosmetic surgery and billing insurance
    Medical Coding Books
    If a patient is having cosmetic surgery done that we know isn't covered by their insurance, can we legally bill the insurance knowing its not covered?

  2. #2
    Quote Originally Posted by lalalisa View Post
    If a patient is having cosmetic surgery done that we know isn't covered by their insurance, can we legally bill the insurance knowing its not covered?
    Yes, but if it's Medicare, get an ABN. And I'd get payment up front, if I were you.

  3. #3
    Columbia, MO
    You should use a V50.x diagnosis code as the first listed dx code also.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Milwaukee WI
    Default Policy for Cosmetic procedures
    Your practice should have a policy in place for Cosmetic Surgery.

    As an example .... All procedures defined as Cosmetic Surgery must be paid for in advance. No claims will be filed to insurance by the physician practice.

    You can include statements about the percentage discount from fee schedule for advance payment, budget payment plans, the percentage required in advance vs after surgery (pay in full? 50% down?), length of time for payment (90 days post surgery? 30 days?), expanded global period (one Plastic Surgery practice I know of has a 1-year global period on cosmetic procedures), and measures you will take to recover payment if patient fails to pay as agreed (collection agency, reporting to credit bureau, etc).

    In our case - payment must be made in full (to surgeon, anesthesiologist and facility) at least 10 days in advance of scheduled surgery, and we will NOT bill to any insurance at all. We create a dummy invoice to hold the payment until the surgery takes place; once the surgery is "invoiced," the credited amount is transfered to the "billed" invoice as payment in full.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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