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How to charge for 2nd, 3rd, & 4th procedure

  1. #1
    Default How to charge for 2nd, 3rd, & 4th procedure
    Medical Coding Books
    If a patient was to have and excision of a cyst in the breast this would be code #1, with closure layered intermediate #2, excision of cyst in neck code # 3. Code one would be full price, code 2 would be 1/2 price, and code 3 would be ?

  2. #2
    Location
    Hartford, CT
    Posts
    723
    Default
    Charge your full price for all procedures, the insurance company will take the discounts according to their policies. Usually full allowed amount for the first procedure, 50% for the 2nd and 25% for each additional. You should check with the payer to find out how exactly they pay for multiple procedures.

  3. #3
    Default
    I agree with dclark7. Don't forget to list your charges by RVUs, list the highest ones first. You can get your RVUs from the CPT coding companion, or from websites like mediregs.com or code correct. I think Medicare may list them on their website as well.
    K-CPC

  4. #4
    Location
    Milwaukee WI
    Posts
    4,466
    Default Closure may NOT be separately billable
    Depending upon which codes you are using for the excisions (skin lesions vs breast cyst vs musculoskeletal codes for neck cyst) the closure of the surgical wound MAY be included and not separately coded.

    CPT 19120 (excision breast cyst) and CPT 2155X (excision tumor, soft tissue neck) both INCLUDE closure of the operative wound.

    Excision of SKIN lesions (CPT 114xx for Benign lesions; CPT 116xx for Malignant lesions) DO allow for separately reporting intermediate or complex closure.

    Be sure to read your guidelines.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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