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Review - Multiple & Bilateral Surgical Procedures - FOR - SLATE - UPDATED

The document outlines the billing procedures for multiple and bilateral surgical claims, detailing how to bill different surgical procedures performed by the same surgeon. It specifies that OHIP pays 100% for the main procedure and 85% for the secondary one, while bilateral procedures are billed at an average of 92.5%. Additionally, it includes instructions for completing assignments related to these billing practices.

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3 views15 pages

Review - Multiple & Bilateral Surgical Procedures - FOR - SLATE - UPDATED

The document outlines the billing procedures for multiple and bilateral surgical claims, detailing how to bill different surgical procedures performed by the same surgeon. It specifies that OHIP pays 100% for the main procedure and 85% for the secondary one, while bilateral procedures are billed at an average of 92.5%. Additionally, it includes instructions for completing assignments related to these billing practices.

Uploaded by

dg6699work
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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OADM29798

Medical E-
Billing &
Scheduling
Review: Multiple & Bilateral Surgical
Claims

This Photo by Unknown Author is licensed under CC BY-NC-ND


Multiple and Bilateral Surgical Procedures
• Multiple Surgical Procedures:

• When more than one surgical procedure is carried out by the


same surgeon, under the same anesthesia.
• These procedures will have different diagnostic codes.
• OHIP will pay for both services, but will not pay the full
amount.
• OHIP pays 100% of the value of the main (more expensive)
procedure, and 85% of the lower value procedure.
Multiple Operative Procedures
Multiple Operative Procedures
Multiple Operative Procedures in YMS
• Bill the main (more expensive) of the
two procedures first
• Use the “Add to” button to add the
less expensive procedure to the first,
and adjust the amount billed to 85%
• Click the downward arrow next to the
“Amount Billed” to modify the value.
Bilateral Surgical Procedures
• Bilateral Surgical Procedures are the same surgery,
performed twice (once on each side of the body), under the
same anesthetic.
• Think back to bilateral/unilateral billing we have done
before.
• This is the same concept. If a service is listed as “unilateral,”
but you perform it bilaterally, you will bill it twice.
Bilateral Surgical Procedures
Bilateral Surgical Procedures
• When we bill Multiple (different) procedures, we bill the
higher value code at 100%, and the lower at 85%
• With bilateral surgeries, which are the same surgery twice,
both surgeries have the same value.
• To account for this, bill the surgery, change the number of
services to two, and click the downward arrow beside
amount billed to confirm that it shows 92.5%
• 92.5 is the average of 100% and 85% ([100 + 85]/2 = 92.5)
Bilateral Surgical Procedures
• When you enter a unilateral
surgical procedure, and
change the number of
services to 2, YorkMed will
automatically enter the
92.5% … However, you must
click the downward arrow
and confirm that it says
92.5%
• If you do not confirm,
YorkMed will not apply the
change.
Bilateral Surgical Procedures
• Note: if a procedure is listed as “unilateral or bilateral,” the
number of services should be left at 1, regardless of whether
it was performed on one or both sides
Bilateral Surgical Procedures
• If a surgery is listed as “unilateral,” and therefore eligible for
bilateral procedure billing, but it was only performed on one
side, the number of services should not be changed to 2.
• This is not a bilateral surgery. In this case, the surgery is
performed unilaterally.
Take up Homework
• Activities 10-1 & 10-2 – answers posted in SLATE
• Date of Service was indicated on the activity
Schedule – 10-1 & 10-2
Billing Journal: 10-1 & 10-2
Assignment 3 – Multiple &
Bilateral Operative Procedures
• This assignment must be completed individually. Anyone found
in violation of that may be penalized as per the OA Policies and
Procedures Guidelines.
• This assignment allows the use of the SOB (Schedule of
Benefits), YMS and the Diagnostic Manual only. Please close
all other applications/windows and all websites (except SLATE),
when completing this assignment.
• Note: There are 15 questions on this assignment, and you will
be given 60 minutes to complete and submit the assignment.
~~Please note that CORRECT SUFFIXES MUST BE ENTERED for all
service codes, so be sure to enter full 5-character service codes
in order for your answers to be marked as correct.~~

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