aadair
Contributor
Advice please on reimbursement for CPT codes listed as "0" on the RVU schedule under Column S for Multiple Procedure. I work for an anesthesia group. Our anesthesia heart claims are billed with CPT 36620 for the arterial line and CPT 36556 for the central line along with CPT 93503 for the Swan Ganz. We bill CPT 36556 with a 59 to show it as distinct and separate from the Swan Ganz. I have run into an issue with one insurance company now reducing payment for CPT 36620 and CPT 36556 to 50% citing the "multiple surgery rule".
Please reference the AAPC article by John Verhovshek called "Coding and Billing Multiple Procedures" December 17, 2018. I have always found this article helpful with the explanation for the multiple surgery rules. In this article, it is stated "If the code is assigned a “0” in column S, no payment adjustment rules for multiple procedures apply. Per the Centers for Medicare & Medicaid Services (CMS), “If procedure is reported on the same day as another procedure, base the payment on the lower of (a) the actual charge, or (b) the fee schedule amount for the procedure.” Both CPT 36620 and CPT 36556 have a "0" and, it is my understanding, should be exempt from multiple surgery payment reductions. In my many years working with anesthesia, we have rarely had issues with any insurance not paying these codes at 100% on our anesthesia claims.
I now have one insurance company stating that because CPT 36556 and CPT 36620 are not listed in Appendix D and E of the CPT book, they can be reduced by 50%?? I have provided them with the 2022 National Physician Fee Schedule RV File showing under column S these codes are exempt. Despite this supporting information, the insurance company is upholding the multiple surgery reduction in payment.
Please advise if this is appropriate for an insurance company to reduce these two codes citing multiple surgery even though the RVU lists these codes as exempt. It puzzles me that Medicare and all other insurances pay these two codes on our anesthesia claims at 100% according to the Medicare RVU's but this one insurance company disputes that because they are not listed under Appendix D and E in the CPT book and the reduction is appropriate? Any assistance or advice is greatly appreciated! Thank you!
Please reference the AAPC article by John Verhovshek called "Coding and Billing Multiple Procedures" December 17, 2018. I have always found this article helpful with the explanation for the multiple surgery rules. In this article, it is stated "If the code is assigned a “0” in column S, no payment adjustment rules for multiple procedures apply. Per the Centers for Medicare & Medicaid Services (CMS), “If procedure is reported on the same day as another procedure, base the payment on the lower of (a) the actual charge, or (b) the fee schedule amount for the procedure.” Both CPT 36620 and CPT 36556 have a "0" and, it is my understanding, should be exempt from multiple surgery payment reductions. In my many years working with anesthesia, we have rarely had issues with any insurance not paying these codes at 100% on our anesthesia claims.
I now have one insurance company stating that because CPT 36556 and CPT 36620 are not listed in Appendix D and E of the CPT book, they can be reduced by 50%?? I have provided them with the 2022 National Physician Fee Schedule RV File showing under column S these codes are exempt. Despite this supporting information, the insurance company is upholding the multiple surgery reduction in payment.
Please advise if this is appropriate for an insurance company to reduce these two codes citing multiple surgery even though the RVU lists these codes as exempt. It puzzles me that Medicare and all other insurances pay these two codes on our anesthesia claims at 100% according to the Medicare RVU's but this one insurance company disputes that because they are not listed under Appendix D and E in the CPT book and the reduction is appropriate? Any assistance or advice is greatly appreciated! Thank you!
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