Author Topic: Facility OR Charges Separated into Multiple Procedure Codes  (Read 196 times)

Harry_Ida_Kearns

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Facility OR Charges Separated into Multiple Procedure Codes
« on: April 16, 2021, 07:43:56 PM »
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

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Re: Facility OR Charges Separated into Multiple Procedure Codes
« Reply #1 on: April 16, 2021, 10:25:26 PM »
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.  :)
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Harry_Ida_Kearns

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Re: Facility OR Charges Separated into Multiple Procedure Codes
« Reply #2 on: April 19, 2021, 04:22:37 PM »
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

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Re: Facility OR Charges Separated into Multiple Procedure Codes
« Reply #3 on: April 19, 2021, 10:39:45 PM »
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?
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ace

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Re: Facility OR Charges Separated into Multiple Procedure Codes
« Reply #4 on: April 22, 2021, 03:32:40 PM »
Hi. Can someone help me with testimonials for my website..Specifically for Home health credentialing and billing...thanks

Michele

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Re: Facility OR Charges Separated into Multiple Procedure Codes
« Reply #5 on: April 22, 2021, 05:14:55 PM »
Testimonials have to come from current or past clients.  I'm not sure how anyone on the forum can help with that.

Do you have any clients you can ask?
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Harry_Ida_Kearns

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Re: Facility OR Charges Separated into Multiple Procedure Codes
« Reply #6 on: April 22, 2021, 11:08:27 PM »
I am pretty sure they are CPT codes.  The procedure codes are the ones above- 23430, 9824, 29823, along with codes for supplies, anesthesia, room and board, etc. The physician owner of the facility was confused when he saw the charges too- he didn't understand why the procedure codes were on the facility bill, he thought they would only be on the professional services bill.

Michele

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Re: Facility OR Charges Separated into Multiple Procedure Codes
« Reply #7 on: April 26, 2021, 12:33:46 PM »
OK, so the 23430 and 29823 are cpt codes but the 9824 is not a valid rev code or cpt code so I'm not sure what that one is.  When doing facility billing you are billing for the use of the facility.  Usually that is done by using a rev code such as 0360 which is General Classification - OR Services.  Then the cpt code for the procedure may be listed in box 44 just as a note as to what surgery was performed.

Let me back up a little.  Is this billing being done on a UB04 or a CMS1500?

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Jmojica

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Re: Facility OR Charges Separated into Multiple Procedure Codes
« Reply #8 on: May 05, 2021, 07:43:15 PM »
Hi Everyone,
I work at a outpatient facility and the billing is CPT/HCPCS with Rev codes on UB04 or 837i formats. Your charges should be your customary or allowed fee rates. Being that you are a facility with Rev codes, the insurance companies will pay according to the rev codes you enter since it's state driven.
I hope this helps.

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Re: Facility OR Charges Separated into Multiple Procedure Codes
« Reply #8 on: May 05, 2021, 07:43:15 PM »