Wiki Plastibell Removal

[pegjoh5746]

My provider removed a Plastibell in the office. He is not to provider who performed the circumcision. I know that normally this would be covered under the E/M but he feels it should be billed separately since he was not the provider who performed the procedure. Has anyone had this issue before?

 

[Brooke_cale]

There is no removal code for the Plastibell, so you would have to code an unlisted procedure which is almost a waste of time. It needs to be put into the E&M service. If he spends more time talking to the patient/family about it, your E&M code could possibly reflect a higher level

 

[debbiesom]

If it is in the global time of the circumcision you will not get paid by the insurance. You can bill E/M but it should have been told to the patient that they would be responsible for the visit because insurance will not pay for it. Issue is Medicare patients. You would have to get an ABN signed. Best to do is to have the patient go back to the surgeon during the post operative period stating you would gladly see them after that time for any other follow up care.

We had the same issues with Prostatectomies. patients wanted to go to Philadelphia for the surgery but then did not want to travel back there for the post op care. Unless the surgeon agrees to share the service & reimbursement with you, then you can bill with modifiers 54 for the surgeon & 55 for the post op management. Problem is the Surgeon must agree before the surgery so that it can be billed properly.

Debbie
CPC, CUC