Practice Management Alert

Denials may be carrier-specific, so when in doubt, ask Question: We perform many in-office procedures, as well as injections. Is there a way for us to bill for the supplies we use in the office, or do we have to always assume the carrier includes the surgical and drug supplies in the procedure code so we cannot separately bill for them? Knowing whether or not to bill for procedure supplies, such as surgical trays, and drug supplies can be a challenge. Because payers won't reimburse you for many supplies, the easy solution might be to not bill for any and avoid the hassle of denials. But if you don't bill for supplies when appropriate, you could be shortchanging your practice. Increased Payment Often Means Included Supplies If you perform office-based (non-hospital) procedures, most insurers include payment in the procedure's fee for supplies, such as needles, surgical trays, catheters, dressings, sutures, guides, scalpels and puncture sets. And even when a carrier doesn't bundle the supplies in the procedure's surgical package, the policy may not pay on the supplies, says Catherine Brink, CMM, CPC, CMSCS, president of Healthcare Resource Management in Spring Lake, NJ. Payers normally reimburse facilities (such as hospitals or ambulatory surgical centers) directly for these costs when your physician performs the procedure at the facility. But even though HCPCS codes exist for many of these items (such as A4550 for a surgical tray), most insurers will not pay for the supplies separately when the physician performs the surgical procedure in an office. How it works for Medicare: The Medicare Physician Fee Schedule usually reimburses more for nonfacility (office-based) procedures than those performed in a facility. Medicare reasons that the office procedures include payment for the drugs, supplies and equipment that the physician uses during the in-office service. Because hospitals bill for these supplies independently, physicians who perform hospital-based procedures will collect reimbursement for the professional procedure only and not the supplies. Example: If your physician administers a nebulizer treatment for an asthma patient, you wouldn't bill for the tubing and mask. Because a nebulizer treatment always uses the tubing (A4616, Tubing [oxygen], per foot]) and mask (A7015, Aerosol mask, used with DME nebulizer), code 94640 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device]) includes these supplies, and carriers won't pay you separately for them. Don't forget to bill for the drug if your office supplied it. In this example, if your physician used Albuterol in the nebulizer, J7602 (Albuterol, all formulations including separated isomers, inhalation solution, FDA-approved final product, noncompounded, administered through DME, concentrated form, [...]