Wiki 52000 and 64566 why the multiple rule ?

[bill2doc]

Can someone explain why I'm getting paid in full for the cysto 52000 and half for the 64566even though these are for seperate Dx and seperate site of body. I appended -59 ? Please help

 

[Greyhound44]

Could depend on your payer. Some payers do not recognize separate dx/different site.

 

[bill2doc]

Medicare Nevada

 

[Greyhound44]

Medicaid in Arizona does not recognize different site/dx code. They pay 100% first surgery & 50% for any procedure there after. Perhaps NV is following the same concept.

 

[ckkohler]

Most payers abide by the multiple surgery rule regardless if dx's and body parts are different...the procedure with highest RVU gets the primary payment...