Answer: You can always raise your fee, but you will only get what the plan pays for each code. If you are saying that private payers allow more for 52332 (cystourethroscopy, with insertion of indwelling ureteral stent [e.g.,Gibbons or double-J type]) than for 52351 (cystourethroscopy, with ureteroscopy and/or pyeloscopy; diagnostic), and you report reduced fees for modifier -51 (multiple procedures) services, change the reporting sequence by billing 52332 as the primary procedure and 52351 with modifier -51. If you are saying that the payer allows 100 percent of the billed charges, you could raise your fees. It can be done, depending on the method the practice uses for establishing/updating fees. Remember, however, not to charge a Medicare patient more than you would charge any other patient. |