Wiki Payers reducing E/M payments 50%

[CatchTheWind]

I recently read an article warning that some payers have begun to reduce payment 50% on E/M codes (like a multiple surgery reduction) if there is a procedure done the same day. Has anyone encountered this? If so, with what payer(s)?

 

[Pbhatt1]

Reimbursment

It depends on payers contract and also coding guidelines for the procedure. Same day procedure and e/m service for the same diagnoses are bundled. If E/M is related to separated dx then it should be bill with appropriate modifier to the carrier.

Surgical package within global period includes all E/M services for follow-up visits.

 

[thomas7331]

I have come across this, specifically with some managed care Medicaid payers, but I've only seen it rarely and I imagine it gets a lot of resistance from providers. In doing some payment audits for a particular payer that had this in their payment policies, I found that some of their larger contracted provider groups had negotiated an exclusion from this reduction into their contracts as a condition of participation.

 

[CodingKing]

A payer I worked for wanted to start doing this but they didn't want to be the first to pull the trigger. Its something the big payers are considering since after review of records it was found a majority of the time, the standard global pre-op was being counted in the leveling for the supposedly separately identifiable E&M.