How to charge OR Time for Cosmetic and Covered Procedure

elisa.paul@montagehealth.orgelisa.paul@montagehealth.org
in GENERAL

How are you charging/billing for the facility OR time when both a cosmetic and a medically necessary (covered) procedure are performed during the same OR encounter?

How are you charging/billing facility OR time when two surgeons are involved? One performing cosmetic and second performing medically necessary procedure in same OR encounter?

Anesthesia - same questions for facility rev code 370

Recovery - same questions for facility rev code 710

Comments

  • dwilliamsrsidwilliamsrsi

    Typically, the time for each procedure would be documented in the medical record. I have typically seen this as noted in the section where the OR time is documented or in the circulator notes. Then, the time is billed accordingly based on the medically necessary procedure and the cosmetic procedure. The anesthesia time would follow the same time parameters as the anesthesia would be related to the individual procedure. We used to prorate the Recovery time based on the amount of OR time for each procedure. For example, if the medically necessary procedure was 75% of the total OR time, then we billed 75% of the Recovery time and the rest to the cosmetic surgery. We had a policy that said this was our process.

  • kay.larsen@ah.orgkay.larsen@ah.org

    Do you then split bill the claim? One claim for the medically necessary procedure and a second claim for the cosmetic procedures?

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