# Multiple procedures



## AC0504 (Feb 12, 2009)

Hello Coders, I have a question and hope someone can help me out.
How does medicare reimburse the physician for this multiple procedures?

47420 22
47505 51
47785 51
44140 51
49000 51
44005 51

And also, can I bill medicare for 4 days E/M before the procedures?
Thank you in advance..


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## mmelcam (Feb 13, 2009)

You can not bill all of these codes together.....49000 & 44005 can not be billed with 47420, 47785, or 44140 per CCI edits.


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## AC0504 (Feb 13, 2009)

Thank you Melissa this is good to know..

What about the 4 days consultation code 99232 before the procedure, is that payable by medicare?


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## mmelcam (Feb 13, 2009)

yes it is


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## FTessaBartels (Feb 13, 2009)

*NOT 4 days of consultation*

NO, you cannot bill 4 days of consultation.

At best the first visit is a consultation (depends on the documentation).
Each subsequent visit is billed using the appropriate subsequent hospital visit.
UNTIL you make the decision for surgery!  

So, if on the first visit you decided the patient needs surgery, but were waiting for labs or whatever before going to the OR, then none of the subsequent visits is billable. 

If you saw the patient day 1, wanted more tests, saw the patient day 2, still waiting for tests, saw the patient day 3, still needed more info, saw the patient day 4 and then decided to perform surgery, you can code for all the visits ... don't forget your -57 modifier on the date decision for surgery was made. 

Be prepared for a denial and need to appeal.  Make sure your documentation supports these codes.

F Tessa Bartels, CPC, CEMC


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## mmelcam (Feb 16, 2009)

The question that was asked was could they bill 4 days of e/m codes before a procedure and that is what I was saying yes to not 4 consultation codes.


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## AC0504 (Feb 17, 2009)

Hi F Tessa and Melissa,

This is great information thank you for sharing.


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