Medicare Compliance & Reimbursement

Reader Question:

Get to Know Pecking Order for CPT® Codes

Question: I know that as a general rule the highest RVU has a higher billed amount and that when you bill you should always put the highest amount first. But when it comes to bilateral surgeries is it true that you would sometimes be prudent to put another procedure first because a bilateral code that was done bilateral/unilateral would still be paid at a reduced allowable? 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. Keep in mind that you should follow this rule of thumb even if your insurer requires you to append [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more