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The Economics of Prefilled Syringes - August 2017 - Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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dure you performed, but didn't change its definition or code. You use modifiers to indicate that the procedure being billed has been modified or altered from its published description, not to seek additional reim- bursement. Use modifier -59 for accurate and appropriate reimbursement when 2 services that normally would be bundled together are in a particular cir- cumstance distinct and separate. For example, a biopsy and an excision of the same lesion usually bundle so you're not reimbursed separately for them. But if you perform an excision of a separate lesion, you'd attach -59 to the normally inclusive procedure code to indicate that the second excision is distinct and separate. You'll leave a lot of money on the table if you don't use -59 when appropriate, or if you use it incorrectly. Take a colonoscopy, for exam- ple. Let's say the physician removes multiple lesions or biopsies multi- ple sites within the colon. He removes a polyp via snare in the descending colon (45385 primary procedure) and performs a cold biopsy in the transverse colon (45380-59). If you don't bill them sepa- rately or bill them without a modifier -59, you're shortchanging your center. Failing to make adjustment/write-offs. Establish a cap/dollar amount for when administrative approval is and isn't mandatory before adjustment or write-off. It's common for facilities with higher- than-normal days in accounts receivable to never make adjustments/write-offs because: • no policy and procedure is in place; • no cap is given, which allows for automatic adjustments when applicable and without approval, particularly when the account is paid 6 Coding & Billing CB 2 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • A U G U S T 2 0 1 7

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