Medical Billing Forum

Billing => Facility Billing => Topic started by: ssherman on April 26, 2010, 11:30:44 AM

Title: Implant billing
Post by: ssherman on April 26, 2010, 11:30:44 AM

What tips or suggestions can be provided for billing implants in a consistent manner? I am looking to understand what the rules/requirements are related to billing implants performed as part of a surgery in an ASC setting. My primary focus is on out-of-network.

What implant documents are required for billing purposes?

Are there limitations or usual and customary charges associated with billing implants?

I understand that much of implant billing is dictated by predefined contracts; however, how does it work with out-of-network billing of implants?

If an invoice is provided, but no price is listed on the invoice, can the ASC bill any amount for the implant (out of network)? Implants are generally reported under revenue code 278 (itemized) or captured as C/L HCPC codes- can a predefined price be established to cover all implants that can fall under these codes, or is the price to bill largely dependant on the actual price of the implant?

Any other general guidelines or best practices related to implant billing is appreciated! Thank you.
Title: Re: Implant billing
Post by: ssherman on April 29, 2010, 10:48:47 AM
Title: Re: Implant billing
Post by: Michele on April 30, 2010, 07:09:11 AM
sorry - no experience here.   :(
Title: Re: Implant billing
Post by: jaks97 on May 21, 2010, 08:58:27 AM
I work for an out of network facility, we bill the invoice plus 5% and submit the invoice with the claim.
Title: Re: Implant billing
Post by: testboss on November 29, 2010, 07:22:48 AM
WE are doing the same and the best possible way is to consume it.
Title: Re: Implant billing
Post by: tlewis on January 20, 2011, 11:28:59 AM
Fist what HCPC code are you using? if it is for anchor and screws I would use C1713 Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable)
This code will not work for medicare (surprise surprise) for other implants I would use L8699.(doesn't work for medicare either) Generally you can bill cost plus 10% to cover shipping. I always send in an invoice with the cost of the implants or I get a denial stating that an invoice is needed. Since it is out of network and you are not contracted I wouldn't think that they wouldn't  deny the implant, but what I think and what the insurance company think usually don't jive so if they deny I would send in an appeal. I live in oregon and go off of the payment guidelines for work comp that states that implants are covered, so when I appeal I send a copy of the Oregon statute and have gotten paid. Good luck Implants are a pain!!!
Title: Re: Implant billing
Post by: georgina on April 30, 2011, 10:10:59 PM
I don't have many problems with implant billing.  We bill cost plus 250% with rev. 278 and cpt 99070.  Out of network pay according to the patients OON benefits.  It is verified prior to surgery whether implants are covered under their OON policy.  Our contracted payers all have different guidelines for payment of implants.  Some require invoices others don't.  It is important for the physician to mention the specific implants in the operative notes in the event an appeal is needed.