Orthopedic Coding Alert

Question: Are insurance companies allowed to reduce our fees for multiple procedures performed during the same session? If so, should I be reducing the fee before sending the claim?

New Jersey Subscriber

Answer: Many payers, including Medicare, follow a reduced fee policy for multiple procedures performed during the same operative session. Generally, the policy looks something like this:

• Procedure 1 is paid at 100 percent of the allowable

• Procedure 2 is paid at 50 percent of the allowable

• Procedure 3 is paid at 25 percent of the allowable (for some payers) and 50 percent of the allowable (for other payers, such as Medicare).

Important: Even if the payer in question follows a multiple procedure reduction policy, you should not reduce the fee before you send your claim. Let the payer reduce the fee -- that way you don't risk reducing the fee yourself and then having the payer reduce it again.

Hint: If you need to apply modifier 51 (Multiple procedures) to a surgical code, be prepared for multiple-procedure fee reductions.