General Category > General Questions
Facility OR Charges Separated into Multiple Procedure Codes
Harry_Ida_Kearns:
First, let me apologize for asking such a basic question. I know very little about medical billing and coding, but somehow I have become responsible for overseeing our third party medical billing company. The hospital CEO recently saw some charges for an ortho surgery and wanted to know how they came up with the charges for each CPT code billed.
The response was that billing takes the total OR charges for the procedures only (not including anesthesia, supplies etc), divides it in half, and assigns that half to the first CPT code they are given (I assume this means the primary procedure). The other half gets divided among the remaining procedures. For example:
Total OR Charges: $30,000
23430 billed at $15,000 (First Code)
29824 billed at $3,750
29823 billed at $3,750
29826 billed at $3,750
64415 billed at $3,750
Is this best practice? It seems strange to me. But then again, I don't know anything.
Michele:
No question is too basic! But before I can answer I have to ask a couple questions:
Are you billing for the facility or the surgeon?
Are you questioning the amount billed? Or how they broke it down?
I have to know the answer to the first question in order to respond. I'm asking the second question because I'm wondering why the billing service would be determining the amount to charge. :)
Harry_Ida_Kearns:
This is for the billing for the facility.
I am primarily questioning how the charges were broken down, for now, but I also have concerns over the amount charged total- which I understand would not be something to address with billing- we need to look to our chargemaster for that issue, if I understand correctly. Thank you in advance for your help!
Michele:
I am somewhat familiar with facility billing but I'm a bit confused. I have not seen facility billing done where they bill by the procedures, meaning using the CPT procedure codes. Is it not being billed using REV codes?
ace:
Hi. Can someone help me with testimonials for my website..Specifically for Home health credentialing and billing...thanks
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