Gastroenterology Coding Alert

Question: We typically list the code with the highest RVU first on our claims when reporting multiple codes at the same time. But when it comes to bilateral surgeries, should we report another procedure first because a bilateral code that was done bilateral/unilateral would still be paid at a reduced allowable?

Nevada Subscriber

Answer: Yes, you should sometimes put another procedure first. If the 150 percent amount of the relative value units (RVUs) for a bilateral procedure is the highest, you should put that code first.

Here’s why:  Because the insurer will discount the second and subsequent procedures based on multiple procedure discounts, it’s best to list the codes in RVU order, with the highest-paying code listed first.

Payers will determine your primary and secondary procedures in one of three ways:

• According to the relative value unit (RVU) order based on the Medicare fee schedule
• According to the insurer’s own fee schedule
• In the order in which you listed the codes on your claim.