Wiki 64447 Bilateral Reimbursement?

[aadair]

Question regarding reimbursement for a bilateral femoral block done on a patient who underwent bilateral total knee surgery. The anesthesiologist did a right and left femoral block post operatively to manage post operative pain. Blue Cross reimbursed at 150% but office discussion is questioning that each injection should be reimbursed at 100%? I'm questioning the multiple surgery rule because these injections are being done in two distinctly separate sites? Has anyone had any experience with bilateral femoral block insurance payments. Thank you!

 

[m.j.kummer]

Question regarding reimbursement for a bilateral femoral block done on a patient who underwent bilateral total knee surgery. The anesthesiologist did a right and left femoral block post operatively to manage post operative pain. Blue Cross reimbursed at 150% but office discussion is questioning that each injection should be reimbursed at 100%? I'm questioning the multiple surgery rule because these injections are being done in two distinctly separate sites? Has anyone had any experience with bilateral femoral block insurance payments. Thank you!

I agree with you. If they had been done on different days there would be no reduction. I would appeal it. I am going to watch this post and see what some with this experience offer. Great post!

 

[marvelh]

Reimbursement for bilateral procedures is similarly reduced, typically at 150% of the allowable for a unilateral procedure.

64447 carries a "1" bilateral status indicator in the Medicare Physician Fee Schedule with
1=150% payment adjustment for bilateral procedures applies. If the code is billed with the bilateral modifier or is reported twice on the same day by any other means (e.g., with RT and LT modifiers, or with a 2 in the units field), base the payment for these codes when reported as bilateral procedures on the lower of: (a) the total actual charge for both sides or (b) 150% of the fee schedule amount for a single code. If the code is reported as a bilateral procedure and is reported with other procedure codes on the same day, apply the bilateral adjustment before applying any multiple procedure rules.

Majority of payers follow Medicare's stance on procedures that can be reported bilaterally.