Question: What is a best practice for splitting charges when a patient has multiple procedures at once? For example, we had a workers' compensation case for a hernia repair, and the patient chose to have another hernia repaired while in surgery.  

Two experts answered this question submitted by Melanie Emter, finance director, Livingston Healthcare, Livingston, Mont., and a member of HFMA's Montana Chapter (melanie.emter@livingstonhealthcare.org).  

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Answer 1: Usually for a procedure that occurs in the operating room (OR), the Current Procedural Terminology (CPT) code(s) appends to revenue code 360. Unless your chargemaster is set up, bill on a per-procedure basis.

This question was answered by Caswell Samms, vice president of revenue cycle, St. Barnabas Hospital, Bronx, N.Y., and a member of HFMA's Metropolitan New York Chapter (csamms@sbhny.org). 


Answer 2: I can explain our procedure, which resulted from system constraints. I don't believe this is a best practice, but it is the approach that we use and have seen used by other hospitals.

Our system will allow the medical records department to code multiple OR procedures to revenue code 360. All of the charges for the revenue code are linked to the first line item on the bill, which causes the bill to look like this:  

Revenue Code CPT-4 Code Amount Charged
360 ###01 $1,000.00
360 ###02 $0.00
360 ###03 $0.00



The following is our procedure for splitting charges:

  • We split the charge between the line items based on how many procedures were performed. 
  • If there were two procedures, the total charge for the OR is split 50/50. 
  • If there were three procedures, the total charge for the OR is split by one-third for each procedure.

It is not perfect because you may end up charging a different amount for the same procedure based on the number of other procedures performed. We have been able to justify this approach due to the fact that our OR charge is based on time.

This question was answered by Kelly McGinnis, director of revenue cycle, HealthAlliance of the Hudson Valley, Kingston, N.Y., and a member of HFMA's Hudson Valley New York Chapter (kelly.mcginnis@hahv.org). 


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Publication Date: Thursday, May 17, 2012