PAT charges with surgery bill?

TRISLEY

My team is asking me if we should combine PAT visits with the Surgery bill. I'm thinking no because some of the PAT services are not routine for the surgery however isn't there a rule about services that can't be billed out separately prior to surgery?

RHirsch

can you tell us what pre-admission testing you are inquiring about? There is a 3 day payment window rule for Medicare services prior to an inpatient admission so if that applies, you don't bill separately but rather include on the inpatient claim. Other testing should be billed separately, and of course it should be medically necessary. 

dwilliamsrsi

For OP services, where the PAT is performed on a separate day than the surgical procedure, there is no requirement that the PAT be on the surgery claim.  This was a practice many years ago that had as much to do with getting everything on the same account number as it did with billing requirements. This is no longer a concern with the advent of electronic records.   As Dr. Hirsch noted, there should be medical necessity documented for the testing, but it goes on its own claim when performed on a date of service separate from the surgery.  I would also investigate the reasons for why the question has been asked - what is the impetus for combining the services on a single claim.  This may actually reveal another process that needs some attention.  For example, the situation may be that medical necessity is not clearly evident from the information provided  in the order.  Anesthesia may order a CXR on someone  because they are of a certain age, but this may not considered to support medical necessity from a payer's perspective.  

TRISLEY

Thanks all for the feedback!