20160430 - Save up to 35% on Everything You Need to Get Certified | Learn More

Results 1 to 4 of 4

Thread: "Separate Procedure" distinction

  1. #1
    Join Date
    Apr 2007
    Location
    Lincoln, NE
    Posts
    435

    Default "Separate Procedure" distinction

    Does anyone have any insight or advise on "separate procedure" distinction codes. For example, a surgeon performs an inguinal hernia (49505) but also performs excision spermatic cord lipoma (55520). Because these are via the same incision the surgeon is billing for the highest surgically valued procedure 49505 but for anesthesia purposes 55520 has highest value.

    I don't know if I'm overthinking this case but since it's a two unit differential I'd like other anesthesia coder's opinions. Do you feel it is appropriate to bill the 55520/00860 for the anesthesia service in keeping with the ASA Billing Guideline of reporting the code with the highest base unit value?

    Thanks.
    Julie Drueppel, CPC
    Last edited by jdrueppel; 10-13-2008 at 09:11 PM.

  2. #2

    Default Separate Procedures

    Julie,

    It is absolutely appropriate for you to bill the procedure with the highest base value regardless of how the surgeon is billing. The way that I think of it is that our docs are providing anesthesia for all of the procedures during the operating session, so any of them are billable from our standpoint. We should always choose the code with the highest base value in order to maximize our reimbursement. Additionally, when I have two different procedures with the same number of units I always choose the one for which I have the best diagnosis.

    Hope this helps.

    Heather G. CPC

  3. #3
    Join Date
    Apr 2007
    Location
    Lincoln, NE
    Posts
    435

    Default

    Thanks Heather!

    Julie, CPC

  4. #4
    Join Date
    Apr 2007
    Location
    Minneapolis, MN
    Posts
    19

    Default

    Heather,

    A great way to explain something that seems at face value to go directly against the grain of not "coding for dollars"!

    And Julie,

    Heather hit the nail on the head!
    Lisa Gillstrom, CPC, CPBB, HUC
    National Compliance Manager

    himagine solutions inc.
    3109 W. Martin Luther King Blvd., Suite 650, Tampa, FL 33607
    P: 813-331-0645
    lgillstrom@himaginesolutions.com
    www.himaginesolutions.com

Similar Threads

  1. """Looking for on Remote coding Possition""".
    By yeima26@yahoo.com in forum Resume Postings
    Replies: 2
    Last Post: 06-15-2014, 10:13 PM
  2. Modifier 59 with two "separate procedures"
    By fredcpc in forum Modifiers
    Replies: 11
    Last Post: 01-11-2011, 08:30 PM
  3. Trying to code "interstitial prominence" and "peribronchial thickening" using 2007
    By vazquecj in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 03-10-2010, 07:39 PM
  4. Chief complaints: "URI" / "Flu-like symptoms"
    By phillipmanning in forum Emergency Department
    Replies: 2
    Last Post: 11-23-2009, 10:26 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.