The response to a recent question.
Consider if, during the initial consultation, a patient is advised surgery is required. The patient is therefore given a CCSD code equating to the surgical episode to quote to his or her insurance company. Following a conversation between the patient and their insurance company a pre-authorisation code for, as an example, AB1234 is issued to the patient and passed on to the consultant surgeon.
What happens if, during surgery, a change of surgical procedure is deemed necessary? Does it make a difference? Certainly not to the patient and not to the consultant surgeon who has performed what he or she deemed to be the absolutely correct procedure.
The point at which it does make a difference, however, is the fee the amended surgical procedure attracts. For example:
The original code of AB1234 may, for example, generate a fee of £452. But if during surgery, a different procedure was necessary a different code will be applicable. For example XX4268 instead of the original procedure code of AB1234. XX4268 generates a fee of £619.00 whereas AB1234 generates £452.
So the question: which code do you charge for? The XX2468 obviously. But…
There is a step to be taken before the invoice is raised. Best practice is to call the insurance company and explain the situation. All insurance companies are very used to such calls from MHM.
And thus MHM invoices the correct fee and you get paid the right fee.
by 
Leave a Reply