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two surgeons, one surgical session, different procedures

  1. #1
    Default two surgeons, one surgical session, different procedures
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    I hope someone has an answer for me. This is a new one for me.

    I have a patient that had multiple procedures performed by two different surgeons. Not co-surgeons, not assist. All procedures the surgeon's did were not related to each other.

    I have found in the Medicare billing guidelines that the physicians will be reimbursed as normal (100-50-50...). The will be reduced per multiple procedures only if they themself performed multiple procedures.

    But what about the facility? The claims went out seperately (our software system would not allow to bill both physicians' charges on the same claim) and on the first claim they processed they paid as normal: 100%, 50%, etc. but on the second claim they reduced the primary procedure to 57% and the remainder at 50%.

    I've looked all over the internet and Medicare's website and can not find any literature for this.

    Does anyone have any info on surgical situations like this? Is this correct reimbursement? Where can I find some answers?

    I would really appreciate any information any one can offer.

    Thanks fellow coders!!!!

  2. #2
    Default
    ok for that situation each surgeon has to dictate their own op report for the procedure they did. It has to go on the same claim form........ you said that your system does not allow that I really don't know an answer for that not knowing what system you use.For the facility multiple procedure rules apply for payment. for the prof. they should be reimbursed for the procedure they performed. hope that helps. The procedures have to be on the same claim form because the procedures were done on the same dos.
    LG CPC,CASCC

  3. #3
    Location
    Columbia, MO
    Posts
    12,560
    Default
    Quote Originally Posted by tgutierrez View Post
    I hope someone has an answer for me. This is a new one for me.

    I have a patient that had multiple procedures performed by two different surgeons. Not co-surgeons, not assist. All procedures the surgeon's did were not related to each other.

    I have found in the Medicare billing guidelines that the physicians will be reimbursed as normal (100-50-50...). The will be reduced per multiple procedures only if they themself performed multiple procedures.

    But what about the facility? The claims went out seperately (our software system would not allow to bill both physicians' charges on the same claim) and on the first claim they processed they paid as normal: 100%, 50%, etc. but on the second claim they reduced the primary procedure to 57% and the remainder at 50%.

    I've looked all over the internet and Medicare's website and can not find any literature for this.

    Does anyone have any info on surgical situations like this? Is this correct reimbursement? Where can I find some answers?

    I would really appreciate any information any one can offer.

    Thanks fellow coders!!!!
    Are you wanting an answer for the facility claim?

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Default
    Yes, I am looking for facility side of this circumstance. I ended up calling Medicare and they said they were able to understand the circumstance and they review each to determine the reimbursement based on multiple factors to come up with their reimbursement rates. They stated each circumstance is unique and therefore does not have a specific rate for this issue.

    Do you have any additional information on the subject?

    Thanks!

  5. #5
    Location
    Columbia, MO
    Posts
    12,560
    Default
    the facility's claim is not affected by the fact that 2 different surgeons were involved. All procedures go on the same claim, you should not have submitted 2 different claims. you use modifiers for anything that is bundled and that is it. For the facility it is a matter that the OR was utilized and each procedure lets the payer know what was done in that session so that proper payment can be determined.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
    Default
    So does it matter which physician is on the claim form? Does it matter that both physicians aren't on the claim?

    Thanks for all the info!

  7. Default
    I'm curious about this question myself. The ASC I code/bill for also occasionally will have 1 pt, two surgeons, 2 surgeries on the same day, different sessions. Our claims do not print on one claim form either, it generates 2 separate claims. We haven't had a problem, however I do believe 2 claims on 1 day is incorrect.

  8. #8
    Default
    Why would the procedures go out on one claim when there are 2 different providers performing different procedures? With our software if there is a different provider put in for the charges, it generates a separate claim.

  9. #9
    Default 2 surgeons 2 separate procedures
    My question follows the same lines except the procedure my doc did is considered out paitent and the other procedure by the other doc is considered inpatient. Do I bill as in patient or patient? The pt was admitted because of the other procedure

  10. Default
    Quote Originally Posted by mitchellde View Post
    Are you wanting an answer for the facility claim?
    What is one surgeon performs all of the procedure such as placing a port and another surgeon come in only to put a selective catheter in and performs an venogram (75827)? The second surgeon is employed by an outside physicians office who does surgeries' in hospitals and in this case performs services during another surgeons procedure.

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