Medical Billing Forum

Billing => Billing => Topic started by: galinafl26 on December 05, 2012, 05:58:39 PM

Title: BILLING FOR TWO PROCEDURES ON THE SAME DAY
Post by: galinafl26 on December 05, 2012, 05:58:39 PM
HI I AM BILLING FOR AN OBGYN AND HE PERFORMED TOTAL ABDOMINAL HYSTERECTOMY (58150) AND ALSO EXPLATORY LAPAROSCOPY (59000) HOW DO I BILL THEM TOGETHER AND GET PAID FOR BOTH. WHAT MODIFIER WOULD I ADD?
HE ALSO DID AN INITIAL HOSPITAL EXAM (99222)

THANKS EVERYONE!
GAYLE
Title: Re: BILLING FOR TWO PROCEDURES ON THE SAME DAY
Post by: Michele on December 06, 2012, 10:19:27 AM
You cannot just add modifiers to get charges paid.  You will get yourself into hot water that way.  It sounds as if you are the biller, not the coder.  The claim should come over coded complete with modifiers.  There are modifiers to indicate that procedures are separate but without knowing all details or seeing the patient's chart it would be impossible to tell you if they would be appropriate.  You can google "modifiers for cpt codes" to view a list if you don't have one.  They are also posted in the cpt books.
Title: Re: BILLING FOR TWO PROCEDURES ON THE SAME DAY
Post by: galinafl26 on December 07, 2012, 09:17:57 AM
I am not a coder however if I can get advice on something and get paid for it why not? You don't need to be a certified coder nowadays. Everything is available on line! I already got the information and billed it out!
Title: Re: BILLING FOR TWO PROCEDURES ON THE SAME DAY
Post by: PMRNC on December 07, 2012, 09:58:03 AM
Quote
I am not a coder however if I can get advice on something and get paid for it why not? You don't need to be a certified coder nowadays. Everything is available on line! I already got the information and billed it out!

I've been in the insurance/billing industry for about 25 years, I do NOT proclaim to be a certified coder nor would I tell people they don't need to be certified and just find it online and get paid. That's what lands people in jail, YOU bill it.. your libel.  Coding is a high educationally demanding career, certainly they didn't find things "on line".
Title: Re: BILLING FOR TWO PROCEDURES ON THE SAME DAY
Post by: Michele on December 10, 2012, 07:34:59 AM
HI I AM BILLING FOR AN OBGYN AND HE PERFORMED TOTAL ABDOMINAL HYSTERECTOMY (58150) AND ALSO EXPLATORY LAPAROSCOPY (59000) HOW DO I BILL THEM TOGETHER AND GET PAID FOR BOTH. WHAT MODIFIER WOULD I ADD?
HE ALSO DID AN INITIAL HOSPITAL EXAM (99222)

THANKS EVERYONE!
GAYLE

I am not a certified coder.   I am a biller.  If you apply a modifier simply to get a charge paid that is fraud.  If the provider claims they didn't tell you to apply the modifier then it's your butt on the line.  I could have easily told you the modifier you were looking for but that would not have been responsible.  Your question was clearly worded in a manner that indicated that you may not be aware of the liability you could be facing.  Your question "How do I bill and get paid for both" is what concerned me.  Sometimes billers get so caught up in "getting paid" that they cross that line without realizing it.  Nothing should be coded and billed strictly to get reimbursement.  I know many of you are saying "what?"  It's our job to make sure the provider is getting paid.  Yes it is, but not by committing fraud to do so.  You need to know that manipulating codes and/or modifiers strictly to increase reimbursement is a big mistake.

Recent news story in my area:  Provider and their biller up on charges of fraud.