Archive February 2017 XVIII, No. 2

Coding & Billing: How Much Are You Leaving on the Table?

A busy surgical center shares 4 tips to collect all that's rightfully yours.

Caleb Cox

Caleb Cox


Vi Dodd

Vi Dodd, CPC


reimbursed CLEAN CLAIMS Ensuring the accuracy of every claim you submit goes a long way toward ensuring you're fully reimbursed.

As one of the highest-volume multi-specialty ambulatory surgical centers in Virginia, we're always doing the legwork — and, in some cases, the detective work — to make sure we properly code every procedure. After working so hard to bring patients through the door, we don't want to leave a dime we're entitled to on the table. Here are 4 tactics that have worked well for us.

1Compare the facility bill to the op report. When you analyze the facility bill against the surgeon's operative report, it's not so much about correcting incorrect billing; it's about identifying any codes that were left out because the op report wasn't as specific as it needed to be. The op report might say one thing and one thing only, but by looking at each of the steps the surgeon took, including analyzing the materials he used, you might find 5 or 6 other "hidden" codes. Performing comparison audits can uncover CPT codes that you otherwise wouldn't have billed. Each unbilled code you miss and don't bill for represents a lost opportunity, dollars that should have gone to your bottom line.

2The more specific, the better. When it comes to surgical documentation, specificity is your best friend. Learn the types of procedures your doctors are performing and know the proper codes associated with those procedures. Make sure your docs know them, too.

Let's use a retinal detachment case as an example. What type of retinal detachment was it? What type of membrane was removed? If you don't properly document those things, you need to ask follow-up questions, because the codes for each of those things are different — as are the reimbursements.

As an example of omission, let's say an orthopedic surgery op report mentions internal fixation, but there's nothing listed for fixation on the surgeon's bill. It might be something as simple as a screw — another $300, perhaps — that you'll find as a result of the audit. This found money adds up quickly.

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