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Ultrasound for Pain procedures in a hospital

  1. #1
    Default Ultrasound for Pain procedures in a hospital
    Medical Coding Books
    I run an anesthesia group and our hospital has requested us to pay for an ultrasound for pain management cases done in the hospital. I know how much we would get paid for the professional component but is there anyway to find out how much the hospital would get paid. Does their DRG get bumped up? How does that work? Any help would be appreciated. Thank you

  2. Default
    That would depend on if the patient were inpatient or outpatient. If the patient is outpatient, DRG's do not apply and the reimbursement is based on the procedural codes submitted to the insurance company. You would have to contact their billing department and ask for a specific insurance to determine exact payment. This is a difficult question because in most institutions, they have many payors and all are contracted at different rates. They usualy base their financial projections off their "biggest" payor.

    Hope this helps.

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    Outpatient: You can check the Medicare payment in the Federal Register Addendum B; there you will find the APC assignment, status indicator and Medicare reimbursement.(some radiological services may be packaged into the surgical procedure itself).
    Anthony McCallum, CPC, CIRCC, CPC-I, CCS

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