Mulitple procedures

When billing for multiple procedures, I have always been taught that the procedure with the highest RVU should be your primary code and charges are submitted in RVU order. We now have a coder stating it doesn't matter what order the charges are submitted in, therefore, an xray of the surgical specimen could be listed primary over the actual procedure or S&I guidance.

Can anyone direct me to current documention that states procedures should be billed in RVU order?

Thanks for any help given

multiple procedures

I'm not a radiology expert, but these are the two citations I came up with, both can be downloaded at:
http://www.cms.hhs.gov/manuals/iom/List.asp


Chapter 12 of Publication 100-04, in the Medicare manual system, says this about surgical procedures in its instructions about payment for surgical procedures.

Base payment for each ranked procedure on the lower of the billed amount, or:
! 100 percent of the fee schedule amount (Field 34 or 35) for the highest
valued procedure;
! 50 percent of the fee schedule amount for the second highest valued
procedure; and
! 25 percent of the fee schedule amount for the third through the fifth
highest valued procedures;

Chapter 13 of the Medicare Claims Processing Manual is specifically about Radiology procedures, and it may help you. It says this about procedures which are already reduced in RVU amounts in the fee schedule in particular about the SI codes

80.2 - Multiple Procedure Reduction
(Rev. 1, 10-01-03)
Carriers make no multiple procedure reductions in the S&I or primary non-radiologic
codes in these types of procedures, or in any procedure codes for which the descriptor
and RVUs reflect a multiple service reduction. For additional procedure codes that do
not reflect such a reduction, carriers apply the multiple procedure reductions.

Reduction

Medicare will sequence based on RVU value. For private payers, list highest value procedure first followed by next highest, etc.