Wiki Two Seperate Procedures

[tobieforte]

Hi Everyone!

My doctor performed an ankle surgery and hand surgery on the same patient on the same day. Prior to each surgery a time out was performed, and after the first surgery the room was turned over so, it was treated like two separate surgeries. He also dictated two separate op notes. Since this was treated at two separate surgeries, will the insurance reduce the second procedure by 50% if I bill them together? Should I bill them separately? I want to get him the most return but legally.

Thanks!

 

[AlanPechacek]

For what it is worth, your surgeon did two separate procedures on the same patient, on the same day, in the same Operating Room, and under the same (one) anesthetic, regardless of the Time Outs, the turn over of OR and supplies, and the number of Op Reports he dictated. I doubt that the insurance company is going to let you get away with filing two different/separate claims, as they will probably look at them and combine them into one. It would be "safer" to submit them one one claim, and use whichever Modifier 59 variant applies to the lesser valued of the two procedures.

Respectfully submitted, Alan Pechacek, M.D.
icd10orthocoder.com

 

[mitchellde]

I must agree with Dr. Pechacek, you may not need a modifier since one was hand and the other an ankle, so you should not have a bundle issue. However the payer will in all likelihood discount the second procedure. Just be sure to list the higher RVU procedure first. If you submit two claims for the same date of service you will risk neither being paid due to duplicate claim.