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MO HealthNet Internet Provider Training Program Presented by the Provider Education Unit MO HealthNet Division. MULTIPLE SURGICAL PROCEDURES. Presented by the Provider Education Unit MO HealthNet Division. Information regarding multiple surgical procedures can be found in Section 13.40.F

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Presentation Transcript
slide1
MO HealthNet Internet

Provider Training Program

Presented by the Provider Education Unit

MO HealthNet Division

MO HealthNet Division

multiple surgical procedures
MULTIPLE SURGICAL PROCEDURES

Presented by the Provider Education Unit

MO HealthNet Division

MO HealthNet Division

slide3

Information regarding multiple surgical

procedures can be found in Section 13.40.F

of the Physician Provider Manual. To access

the manual go to the MHD Public Web site

www.dss.mo.gov/mhd/providers/index.htm.

In the left hand column, click on Provider

Manuals.

MO HealthNet Division

slide4

When multiple surgical procedures are

performed for the same body system

through the same incision, the major

procedure is considered for

reimbursement at 100% of the allowable

fee for the procedure.

MO HealthNet Division

slide5

Multiple surgical procedures performed on

the same participant, on the same date of

service, by the same provider, for the same

or separate body system through separate

incisions must be billed as follows:

  • The major, secondary and tertiary procedures should be indicated on the claim form using appropriate CPT codes.

MO HealthNet Division

slide6

A copy of the Operative Report must be

attached to the paper claim for multiple

surgeries to provide additional

information and to assist in the

reimbursement process.

MO HealthNet Division

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Claims for multiple surgeries are allowed

according to the following:

  • 100% of the allowable fee for the major procedure
  • 50% of the allowable fee for the secondary procedure
  • 25% of the allowable fee for each additional procedure

MO HealthNet Division

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An exception to the multiple surgical

procedure policy is diagnostic

endoscopies.

When more than one diagnostic endoscopy

is performed on the same day with the same

or different approaches, but different

instruments, both are reimbursable at 100%

of the allowable fee for the procedure.

MO HealthNet Division

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When more than one diagnostic

endoscopy is performed on the same

day using the same approach and the

same instrument, only the major

procedure is reimbursable.

MO HealthNet Division

slide10

Thank you again for participating in

this training program. If you have

questions regarding the information

in this presentation, please contact

the Provider Education Unit at

573-751-6683.

MO HealthNet Division