Cosmetic Surgery 2007 Changes - PowerPoint PPT Presentation

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Cosmetic Surgery 2007 Changes

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  1. Cosmetic Surgery2007 Changes 28 June 2007

  2. Overview • New pricing as of 30 June 2007 • New documentation, only need super bill, not cover document • Included things like location, anesthesia, bilateral on super bill • Added LOTS of unlisted procedures • Added ability to bill for inpatient stays for many procedures • Determining CSET “primary” (the one that goes in blocks 1-3, all the others go in block 7) procedure and then additional procedures that may be reduced • Session plus substance (chemical wrinkle removal) • Medically necessary at same time as cosmetic • Admitted due to complications

  3. Super Bill Completion • ICD code V50.1 or V50.0 (for hair) – use as initial for treatment, use as 2nd for follow-up

  4. Patient Data/Anesthesia • Need surgical date so MSA can obtain post procedure documentation to assure that what was paid was received • Anesthesia same as last year, general/MAC and moderate all cost money!

  5. Description/Codes/Bilateral • Description • CHCS Code • MSA Code • Bilateral • # in CHCS • # in MSA

  6. Description/Codes/Bilateral • CHCS Code/MSA Code/Bilateral/# in CHCS/# in MSA 17999 – Unlisted procedure, skin, mucous membrane and subcutaneous tissue To assign a separate price, need separate codes In DoD we will use “Yxxxx” as the “code” to generate pricing in CSET In MSA module when entering, Use “Self Pay Procedure, Procedure’s date, and list primary “Yxxxx” code

  7. Bilateral • Only those that are “open” (not shaded) could be bilateral. If so, then in the bilateral block, enter a “yes” so MSA can bill appropriately

  8. Added LOTS of Unlisted Procedures (look for 17999 and 21899) • Laser Procedures • Hair Removal • Skin Resurfacing • Tattoo Removal • Treatment of spider veins • Microdermabrasion • Liposuction • Ultrasound assisted • Microlipoinjection/fat transfer • Breast-Reduction/Revision • Nipple reduction • Nipple enlargement • Breast reduction for men (Gynecomastia) • Pectoral augmentation (men) • Immediate insertion of implant • Other Revisions • Lip augmentation • Buttock augmentation • Calf augmentation • Umbilicoplasty • Chemical • Restylane • Zyplast • Zyderm • Radiance • Micro/mini hair graft

  9. Inpatient Stay Option for Outpatient Procedures • Inpatient Stay option • When the Inpatient stay option is elected for those procedures that are usually considered outpatient, the stay will be billed at the Inpatient DRG rate: • The DRG rate (short stay) of $5,530.00 will apply to the primary procedure, which includes; Professional, Anesthesia, and Facility fees • Rate of $1,000.00 will apply to each additional procedure performed during the same Inpatient stay

  10. Admitted due to complications • If reason for Inpatient admission is due to complications; • *DRG costs will change • Patient is responsible for additional costs incurred • Will use DRG based on complication, then using that DRG’s relative weighted product (RWP) multiplied by TMA ASA amount (not the ASA for your MTF) * Recommend contacting UBO helpdesk for pricing

  11. Medically Necessary Performed at same time as Cosmetic • No matter what happens during same encounter, the entire cosmetic procedure will be paid in full prior to procedure • If medical necessity and cosmetic, and patient has OHI, • Patient pays entire cosmetic prior to procedure • Obtain pre-certification for medical necessary procedure prior to procedure • Bill insurance for the medically necessary • Determine the cost for the entire procedure • If insurance payment and cosmetic payment greater than what the entire procedure would be, then the additional amount would be refunded to the cosmetic surgery payment up to the amount the cosmetic surgery patient paid • Total procedure = $10,000. Cosmetic procedure individually = $7,500. Insurance pays $6,000. Total receipt of $13,500 – total procedure of $10,000 = refund of $3,500 to patient

  12. Multiple Procedures When more than one procedure is performed during the same session; • Primary procedure with the highest costs charged 100% of professional and facility fee • See blocks 1-3 in CSET • Additional associated procedure may discounted up to 50% of professional and facility fee • See block 7 in CSET • Additional follicle transplants still charged the $500 for 1-500 follicles

  13. Determining “Primary” procedure versus Additional procedures • If more than one procedure is selected on the super bill; • Enter each procedure in CSET individually (Blocks 1,2,&3) • Note the resulting price in CSET “Total Costs” • Input the highest priced procedure as the “Primary” procedure • Input remaining procedure “Additional/multiple” procedure (Block 7) Primary procedure = Most expensive procedure $$$

  14. Session Plus Substance (Wrinkle Removal) Billing Changes for Botox, Restylane, Zyplast & Zyderm; • Charge per session $200 • Includes staff time and use of clinic • Can only enter quantity of 1, so every time the patient returns (e.g., every 3 months) would need to pay again • Separate charge for substance • Botox $5.19 per unit • Restylane $240 per 1cc • Zyplast • Zyderm • Enter in block 8, enter description, then next quantity, then cost and it will calculate the total cost for that substance

  15. Dental Procedures(lower right of page 2 of super bill) • Porcelain Veneers per tooth $770 • Laser teeth whitening per treatment $500 • Teeth whitening, bleaching • Per arch (maxillary or mandible) $220 • Per external tooth $20 • Per internal tooth (e.g., if tooth discolored internally) $190

  16. Glossary of MSA Procedure Codes Glossary created to describe new cosmetic surgery procedures

  17. Hair Transplants (per 1-500 follicles) • Micro/Mini Hair Grafts priced • Enter in block one for the initial 1-500; then increase quantity 1 for each additional block of follicles • For 750 follicles = quantity 2 • For 2000 follicles = quantity 4

  18. Microlipoinjection Microlipoinjection/Fat Transfer – Harvesting small quantities of fat (2-10cc) via mini liposuction and priced per session plus a separate charge for each injection site • 17999-Y4999 Per session $730 • AND 17999-Y500x each separate area $50

  19. Review