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Correct Billing for Same Day Services

Correct Billing for Same Day Services

Medical billing for same day services can sometimes be confusing. Only skilled professionals can tell the difference between same day services and code them correctly. A good example of same day services that can be confuses involve fine needle aspiration (FNA).

If a FNA is performed on the same day as a more extensive procedure, the Centers for Medicare & Medicaid Services will only pay for the procedure that is more invasive. This is called the “sequential procedures policy” in medical billing. This usually occurs when a physician decides to do a FNA, but later after the procedure, decides it did not accomplish what it was supposed to. That same day, the surgeon decides to do another procedure that is more invasive. In this case, your medical billing would have to bundle the FNA with the more invasive procedure.

However, there is an exception to this medical billing rule. The Current Procedural Terminology code 10021 (fine needle aspiration without imaging guidance) can be reported on the same day as a biopsy if the two procedures involve two separate encounters or they involve two separate body sites. If this is the case, you should use the modifier 59 (Distinct procedural service) in medical billing to tell the payer the reason for separate bills. This will increase the likelihood of reimbursement for both procedures if they meet the criteria.

If you are finding keeping up with the fast changes in the world of medical billing and coding is starting to drag your practice down, consider outsourcing your medical billing to the pros that know how to get you the maximum reimbursements on your services-every time!

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