Billing Guidelines for Global Surgery Modifiers

The global surgical package, also called global surgery, includes all the necessary services normally furnished by a surgeon before, during, and after a procedure. Medicare payment for a surgical procedure includes the pre-operative, intra-operative, and post-operative services routinely performed by the surgeon or by members of the same group with the same specialty. Physicians in […]

Understanding ‘Separate Procedures’ in Surgery

Defining ‘Separate Procedures’ According to CPT® surgery guidelines, some of the procedures or services listed in the CPT® codebook that are commonly carried out as an integral component of total service or procedure have been identified by the inclusion of the term ‘separate procedure.’ The CPT codes designated as ‘separate procedure’ should not be reported […]

General Medical Billing Frauds in Healthcare Practices

Spending on healthcare in the US is intensive as healthcare spending grew 4.6 percent in 2019, reaching $3.8 trillion or $11,582 per person. As a share of the nation’s Gross Domestic Product, health spending accounted for 17.7 percent. However, an important fraction of this money – up to 10% of total health expenditure is wasted […]

Billing Medicare for Assistant at Surgery

An Assistant at Surgery is a provider who actively assists the physician in charge of a case in performing a surgical procedure. A physician, nurse practitioner, physician assistant, or clinical nurse specialist who is authorized to provide such services under state law can serve as a surgery. Medicare considers advanced registered nurse practitioners (ARNP), physician […]

Basics of Co-Surgeon Billing Guidelines

Under some circumstances, the individual skills of two or more surgeons are required to perform surgery on the same patient during the same operative session. This may be required because of the complex nature of the procedure(s) and/or the patient’s condition. In these cases, the additional physicians are not acting as assistants at the surgery. […]

How Does Modifier 62 Affect Reimbursement?

Modifier 62 will be added to claims for procedures designated as “co-surgeon allowed” when a claim for the same procedure code with it has been previously submitted and processed for a different provider. Claims for more than one surgeon should have each surgeon’s provider identification number. The following situations are Considered Co-Surgery: Two surgeons of […]

Use of Modifiers 54, 55, and 56

Using Modifiers, the service or procedure can be altered by some specific conditions but has not been changed in definition or code. The intention of modifiers is to give more specific information about a specific procedure or service that is not already contained in the code definition itself. MBC is sharing more information on Use […]

When will elective surgeries resume?

States are starting to release restrictions on elective surgeries for hospitals. Across the U.S. hospitals have begun to plan when and how they will resume elective procedures. Many states from the U.S., including Georgia, Florida, and Oregon, have already released restrictions on nonessential medical procedures. As soon as the number of confirmed Coronavirus patient rise, […]

Adult Elective Surgery and Procedures Recommendations during COVID-19

To aggressively address COVID-19, CMS recognizes that the conservation of critical resources such as ventilators and Personal Protective Equipment (PPE) is essential, as well as limiting exposure of patients and staff to the SARS-CoV-2 virus. The following recommendations are guidance to limit non-essential adult elective surgery and medical and surgical procedures, including all dental procedures. […]

How to code correctly for laceration repairs?

Answering a few questions will help you code correctly for laceration repairs (such as staples, sutures, or similar closure materials): Was the repair limited to the epidermis, dermis, and subcutaneous tissue, or did you need to probe more deeply? Use simple repair codes for superficial wounds (epidermis and dermis) that need only a single-layer closure. […]

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