Separate Charges for Separate Procedures

Neonatal patients seem to present confusing scenarios for many medical billers. It could be due to the fact the patient is so tiny that many of the procedures seem related to split out but in many cases, claims for neonatal services are incorrectly bundled together.

A good case in point would be if a neonatal patient presented with a fever. The physician then did a urine catheterization (51701) and a spinal tap (62270) in the office. In many cases, the medical biller might have bundled these claims together but that would be incorrect as they are two distinctly different procedures even though they were performed at the same visit.

Also, a urine catheterization (51701, Insertion of non-indwelling bladder catheter [e.g., straight catheterization for residual urine]) and lumbar puncture (62270, Spinal puncture, lumbar, diagnostic);do not have edits placed on the code pair by NCCI so no modifier would be required for reporting this procedure. If you do use modifier 51, expect Medicare to reduce reimbursement by roughly 50%.

However, in the case of this type of procedure, your medical documentation documenting both the necessity of the procedures as well as the outcome should be iron clad to insure that you get maximum reimbursements on your medical billing for these services.

View all Articles by: Kathryn Etienne, CCS-P