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General Surgery Coding Alert

Reader Question:

Decide Billing Order for Bilateral Procedures

Published on Thu Jan 19, 2012

Question: When billing multiple surgeries, we usually put the procedure with the highest RVUs first. But when billing a unilateral bilateral surgery, would it be beneficial to put the other procedure first, even if it has lower RVUs than the bilateral code?Arkansas Subscriber Answer: Yes, if the surgeon performs multiple procedures, including a bilateral procedure performed unilaterally, you should sometimes list a lower relative value units (RVUs) procedure first, even if the bilateral code has a higher RVU. That's because a bilateral procedure performed unilaterally would be paid at a reduced allowable anyway. Do this: If the 150 percent amount of RVUs for a bilateral procedure is the highest, you should put that code first. Otherwise, list the other procedure 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 [...]
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