Wiki Office Base Surgery Fee

[COMPauditor]

Has anyone had any luck with billing a surgery office fee for commercial payors. POS would be 11. I've seen providers bill and get paid when billed with CPT 64999.

Some of the items included in this fee are IV administration, transfer patient to and from OR, EKG and vital sign monitoring, etc.

 

[mitchellde]

I have never heard of a provider office being able to use an unlisted procedure code to bill for an overhead fee. The POS of 11 indicates that the procedures reimbursed will have as a component of the reimbursement the overhead portion. You cannot use a procedure code for anything other than a surgical procedure. All of those expenses you have listed are inclusive to the procedure. I am not sure it is illegal but I think it probably comes really close.

 

[COMPauditor]

I must disagree, I don't think that just because they are being done in an Office Setting that they should be "short changed" the things the office and staff do are exactly the same as if done in an ASC, the only thing that is different is the POS.

 

[hgolfos]

I agree with Debra, you can't use 64999 to bill for overhead. Even though your actual procedures are in the nervous system category, you are using the 64999 for things that not only aren't procedures related to that section, but are generally a part of the global surgical package.

Furthermore, just because you are billing it that way (have been for years) and getting paid for it, doesn't mean that it's correct.

 

[COMPauditor]

Is it possible that there is a better code to describe this? I just feel like these offices are doing more than an office based surgery and should be reimbursed for it.