Wiki self pay patient discount?

[coder32]

We have a patient that went from a vaginal hysterectomy to an abdominal hysterectomy? We are trying to figure out if this had gone to insurance what the insurance would discount for the claim. We discountinued the vaginal hysterectomy so is that the procedure that would get the discount?

 

[TamaraM]

If you go by medicare medicare fee schedule, I believe 2nd procedure is paid at 75% and then after that 50%, I believe after 4 then procedures are paid at 25% if proven not to be components.

 

[rturner96]

If you were to code these procedures, the modifer for aborted/procedure terminated early would be added to the vaginal hyst and would probably be paid at 75%. The abdominal hyst should be paid in full as it ended up being the primary procedure.

 

[FTessaBartels]

OB/GYN not my specialty .... BUT ...

Okay this is NOT my specialty, BUT ...

Logic tells us that there is no way to perform BOTH a vaginal hysterectomy and an abdominal hysterectomy. Unless your patient has two sets of organs!

I believe that you should code ONLY the more invasive procedure (i.e. abdominal hysterectomy).

You'll probably get a better response if you post this question in the OB/GYN forum - and include the scrubbed operative note.

Hope that helps.

F Tessa Bartels, CPC, CEMC