Wiki operative Reports

[kayvon30]

New at billing help with op report attachment

Hello,
I am getting conflicting information on when surgery reports or any physician's notes should be sent with the claim to the payer.
Can someone give me instances when it is necessary or expected to attach an operative report or any doctors notes with the claim sent to the insurances to insure that claim payments are not delayed
Thank you,
Claire

 

[lindacoder]

I send notes with claims that I use an unlisted code and a letter stating why it is unlisted and the closest open code for comparison. Also anytime I use a modifier 22 I send notes as well as short note as to why I expect greater reimbursement (lysis of adhesions lasting over 30 minutes than usual operative time)

 

[kayvon30]

Thank you Linda,
Sounds good to me, I forgot to mention that I was told by this other biller that she sends the physician reports on all surgery, regardless.
If I understand you are stating that it is based on modifiers which would make it a lot simpler and avoid postage cost. So again no need to send the operative reports if no modifiers?
PS: I bill for a neurosurgeon.....
Thank you

 

[stephanie74]

I also only send notes for certain modifers ie:22, 62, 53, 52. Medicare is the only payer I don't send OP notes for unless the reimbursement doesn't meet what they should be reimbursing for those. I then send them with a reconsideration. In my experience always sending OP notes opens you up for a possible audit if you aren't always coding correctly (not realizing it). Hope this helps