Wiki Radical Prostatectomy Billing

[zavalag]

Can a physician bill for this procedure themselves or is it bundled into the hospital DRG for Medicare patients? I have not been able to locate a Medical Policy on Medicare/CMS websites.

A physician is thinking about asking the hospital to pay him/her upfront on Medicare patients as a "Robotic Surgery Assist" Fee. They would still issue an ABN prior to collecting the money from the hospital. Can this be done?

 

[Kelly_Mayumi]

I bill for a physician and he does them all the time. As far as I know, he gets paid for them from insurance.

 

[svanhorn73]

we bill this 55783 all the time and we get reimbursed by all insurance including Medicare. You have to make sure that the primary diagnosis is 185

 

[Kbirchmeier]

Modifier 22

We recently received info from an external audit that when the physician uses the robot for surgeries to add modifer 22. Am wondering if anyone has experience with this?

 

[Kelly_Mayumi]

No, I do not add -22 for robotic surgeries. I use the laparoscopic counterpart to report the service.