General Surgery Coding Alert

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 listed first. Keep in mind that you should follow this rule of thumb even if your insurer requires you to append modifier 51 (Multiple procedures) before you submit the claim.

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.