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Ov with office surgery

  1. #1
    Default Ov with office surgery
    Medical Coding Books
    Our new EMR trainer told physician it will generate more revenue if they billed an OV with there scheduled office surgeries. I am telling them there is nothing additional the pt is seen for you cant do this.. But they said they want to do it anyway.. I am very concerned the EMR trainer suggested this type of process . I am concerned later I shall be in trouble too.. What should I do??? Any info would be great we dont see much medicare patients so the doctors feel that if the privates pay great.. I told them they will conduct auduts and figure it out in 2-3 yrs..

  2. Default

    If I were you I would strongly discourage the physician from billing an E/M on the same day as a procedure. This is a non compliant billing practice. Not only for Medicare but also Commercial carriers.If the office procedure is prescheduled and the MD has already made the medical decision to perform the procedure, the procedure alone should be billed.


  3. Default
    I agree with Laura. Unless there's a separate problem being addressed, there's no medical necessity for the office visit charge.


  4. Default not separately billable
    Once the decision for surgery is made, the global period is in effect. You can't bill for a visit related to the surgery. If the patient came in for something, say a retained foreign body, and the physician performed a removal the same day, you could bill for the visit and the procedure.

  5. Default OV with office surgery
    I would also be very concerned. It is not billable the way you have described: the decision for surgery was made in the past not during the visit when the surgery took place. In the past when I have strongly disagreed with the provider and they insisted that something be billed out in a manner which I knew was incorrect and they insisted anyway, I was very careful to make a note that it was billed in that manner per the providers instructions and against my recommendations and I would not take responsibility for it, but you can still get in hot water if you know about the activity and did nothing. Also, why is an instructor in EMR software instructing your practice on coding principles? Are they also certified coders or the vendors simply instructing you in the use of their EMR and trying to help justify the cost of the software? Be very careful as you can also be held accountable if you are aware of inappropriate billing practices and do not act. Your providers are putting you in a very precarious situation which, in my opinion, is simply not worth the risk. It does not pay in the long run to get too "creative" with known billing protocol's.

    Go online to reputable sources and find the references you need to show your provider that what they are asking you to do is inappropriate, also show them how to look up the list of CIA's and exclusions from the office of the OIG and ask them is it really worth a few office visits billed inappropriately?

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