Posted on 26. Aug, 2009 by in Hot Coding Topics
This week is the 400th anniversary of Galileo’s telescope, so let’s celebrate in our own small coding way and get our own scope coding correct.
If your physician performs several knee arthroscopies on the same patient on the same day, you’ll need to understand the multiple- scope rule to determine which procedures you can actually claim — and get paid for.
Important exception: Keep in mind that the multiple scope rule is a Medicare creation. The rule applies mainly to shoulder and knee procedures in the orthopedic practice, for example, but it also affects those of the elbow, wrist, and hip. On the other hand, it does not apply to ankle or metacarpophalangeal (MCP) arthroscopy, and it doesn’t affect arthroscopically aided procedures (29851, 29855-29856, 29888-29889, and 29892). In addition, some surgical knee arthroscopies are excluded from the family – specifically, 29866-29868.
Follow these 4 expert-approved tips to clinch your coding every time.
1. Look to CPT for Scope ‘Families’
Before worrying about how to apply the multiple scope rule, you must know why and when it applies. The multiple-endoscopy rule is Medicare’s way to avoid paying twice (or more) for “inclusive” services by reimbursing only a portion of any scope performed at the same time as another scope of the same basic type, says Tara L. Conklin, CPC, a coding analyst at CodeRyte in Bethesda, Md.
Here’s how the rule works:
CPT divides groups of similar codes into so-called “families.” The first code (the base or “parent” code) describes the basic procedure.
Following the base code, CPT lists any variants that “go beyond” (are more extensive than) the base code, says Marvel J. Hammer, RN, CPC,...
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