Forum - Questions & Answers

Jan 29th, 2015 - Jsmith201400 25 

Outpatient procedure

Dr. performed an outpatient procedure CPT® codes 63685 and 63650. He does not want to bill the professional component. I feel that we have to bill something. Can modifier 52 be used?

Jan 29th, 2015 -

re: Outpatient procedure

if the provider discontinued the procedure you should use modifier 53 on both procedures, you will be reimbursed for the procedures but at a lower rate per the contract with the insurance co. if you look on page 458 of the 2015 CPT® book it will give you a description of how this modifier is correctly used:)

Jan 29th, 2015 - Jsmith201400 25 

re: Outpatient procedure

Thanks. The problem is that he completed the procedure. The patient was discharged but had to return to the ER. I told him that if he completed the procedure he had to bill for the professional component. He did not want to. The hospital of course is billing the TC component.

Jan 29th, 2015 -

re: Outpatient procedure

the provider can still bill for the procedure, but when your entering the code in your charge master, you can "0" out the monies so that way he has a record of doing the procedure but not billing the insurance or patient for a proceduere that he felt was in his error....just a thought, we do it at the practice I work for, I still enter the codes, but if the provider decides he does not want to bill the patient I just correct the $ amount to be 0 and the claim will not file to insurance w/out any monies attached:)

Jan 29th, 2015 - Jsmith201400 25 

re: Outpatient procedure

Thank you.

Jan 29th, 2015 -

re: Outpatient procedure

I'll throw a little wrench in this, but you can ignore it. Waiving a patient charge because of an error may be considered a reportable event. The doctor should contact his/her medical liability carrier and discuss the situation. And hopefully risk management at the hospital was notified.



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