multiple procedures with same DOS

Please explain why we got paid for nearly nothing with the following code combination on the same dos claim

proc 31623 mod 51 allowed 1.44 (CO-45 and CO-59)

proc 31624 mod 51 allowed 1.95 (CO-45 and CO-59)

proc 31625 mod none allowed 193.17 (CO-45)

proc 99220 mod none allowed 0 (CO-97)

re: multiple procedures with same DOS

Was it a planned procedure? If so, then the observation admission would not be separately payable. E/M services on the same day of a planned procedure are not separately reportable. Look at the Medicare Claims Processing Manual, Section 40 on the global surgical rules.

As for the endoscopies, payment for those are also explained in that section. The first is paid at full fee. The second and subsequent are paid at the difference in the RVUs between the RVUs for the second procedure and the RVUs for the base procedure in the family. They are not paid using the multiple surgical rules. Your physician is already being paid for the base procedure using the first code (highest RVU code) and so the subsequent procedures in the same family only pay the difference.