I work for a WC insurance company. A little background, the patient suffered a fracture of left tib/fib in September 2022 and had surgery to repair it. He has surgery again in January 2023 to remove the hardware. The surgeon removes the hardware and places the patient in a circular external fixation device.
I am reviewing an outpatient facility bill. The patient was admitted for hardware removal and the facility billed 20680 along with labs, supplies, anesthesia, pharmacy, recovery room, etc. related to the service.
The surgeon billed 27828-LT, 20692-51 LT and 20680-51 LT.
My question should the facility be billing the same surgical codes as the surgeon. My boss is questioning if the facility billed correctly. If the facility billed like the surgeon, the reimbursement would be less.
I am of the opinion that the facility and surgeon’s bills are not always the same, but now I question if I am looking at this correctly. Where can I find documentation regarding this?
Any assistance in clarifying this for me would be appreciated.
Sue B.
I am reviewing an outpatient facility bill. The patient was admitted for hardware removal and the facility billed 20680 along with labs, supplies, anesthesia, pharmacy, recovery room, etc. related to the service.
The surgeon billed 27828-LT, 20692-51 LT and 20680-51 LT.
My question should the facility be billing the same surgical codes as the surgeon. My boss is questioning if the facility billed correctly. If the facility billed like the surgeon, the reimbursement would be less.
I am of the opinion that the facility and surgeon’s bills are not always the same, but now I question if I am looking at this correctly. Where can I find documentation regarding this?
Any assistance in clarifying this for me would be appreciated.
Sue B.