Wiki Medicaid Billing - Iam just a coder at at our ASC

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codedog

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Iam just a coder at at our ASC, we have two billers also. The billers tell me that Medicaid only pays on one line -one procedure at our ASC. Does this sound right.? When I code from operative report, I code what I see , nothing less , nothing more. Should I just code one procedure when its medicaid ?TRENT ?
 
Hi TRENT,

We also had some payers that would just pay one line and that's it. I do coding and billing at an ASC. I always code the op report, regardless of what the payer pays, line-wise or otherwise. That's what I've always been taught.

Also - I see times when registration gets the payer wrong for a patient so - what happens if the 'Medicaid' turns out to be wrong and it's a commercial payer for coverage? And - I think just from a financial reporting perspective, you want to capture all your charges; if the contractual obligations make you write off all the lines except the first, you need to show that in your financials as write offs.

I hope that helps.
 
What I have noticed with medicaid here is that if you do more than one of a procedure you have to code them separately. It's not that they pay only one line per claim but that they want a line for each procedure even if it's bilateral.
Say my doc removes two lesions from a patients arm and they are both malignant. Each lesion has to be coded out instead of coding one line with 2 units.
 
i also code for an asc, i think i know what they are trying to tell you.

if you bill 45380 and 43239 for the same date of service, and medicaid is the only payor, then you can put both on the same claim form like this 45380, 43239-51

however, in my state, if medicaid is the second payer, they want each line item on its own claim form and attach the same primary eob to each claim. they will see that one is to be reduced for mulitiple proc.

hope this helps
 
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