Wiki Knee surgery-Is there a medicare

[tee512]

Is there a medicare guideline that states knee surgery can not be billed on same day? There is a doctor that is billing a bilateral procedure three days apart for every patient, Can he do this are does it state that he can not if so can you guide me to where it is stated?
Thank you

 

[jojo419]

Knee Surgery

I am assuming you are talking about 2 different legs- left and right? For example, bilateral knee replacements? Documentation should indicate why he is waiting 3 days between surgeries. Many surgeons opt for bilateral knee replacement surgery in one session but it is not uncommon for a surgeon to stage the second knee surgery days or weeks apart.
Modifier 58 is a staged or related procedure by the same physician during the post op period. If this is what the surgeon is doing, then I would use this code.
Read your documentation. Then visit Medicare's website at: http://www.medicarenhic.com and read their surgery guidelines to see how his documentation aligns with his methods of performing surgery. Medicare has lots of manuals you can download and reference and there is one online that addresses this issue.
Hope this helps.