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Re: Blues paying 'second procedure' for Postpartum t/l From: Garry Siegel (garrys@mindspring.com) Sat Mar 16 12:22:48 2002 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Garry Siegel: "OB: Arrest of Dilatation/VBAC/post LEEP" Previous message: art fougner, md: "Re: Blues paying 'second procedure' for Postpartum t/l" In reply to: art fougner, md: "Re: Blues paying 'second procedure' for Postpartum t/l" Next in thread: Kevin Dew: "Re: Blues paying 'second procedure' for Postpartum t/l" Reply: Kevin Dew: "Re: Blues paying 'second procedure' for Postpartum t/l" Joanne's point is probably right to a degree, but Kevin did post the following: "Recently the KY Blues informed we docs that if we do a Postpartum t/l on the same calendar day as the vaginal delivery, they will pay us as if it is a "second procedure" and not at the "full rate" Comments?" Optimally, I want to do my PP tubals whenever I please, and be paid accordingly. Sometimes it is logistically better immediately PP, and at other times 6 hours later, or the next day. I think that we should be paid full fare at any time. Kevin, if what you have posted is correct, then, duh, start doing them the next day for now, until you can fix it. However, Art is really right--we are schumucks! I'm sick of getting poorly paid by carriers with arbitrary rules that violate the CPT ones. For instance, I do a follow up colpo and annual together, as this is easiest and most time efficient for me and my patients. However, as you all guess, sometimes you are paid, and sometimes not. How about finding some endometriosis requiring laser/etc. during an LTL, and billing it any way you want--"-22," or two codes, or whether using the LTL or the ablation lapscope code as the main one. All in all, Art is right. Garry Garry At Sat, 16 Mar 2002, art fougner, md wrote: > >ok so i brought my car to the shop for a tune up, an oil change and >brake pads. i paid for the tune up and then said well, the others are >incidental procedures - i should pay less. the mechanic laughed and >then asked for his money. > >we are schmucks. > >art > >At Sat, 16 Mar 2002, Joanne Bulley, MD wrote: >> >>My understanding of why the "second" procedure is payed at a lower rate >>- is because you don't have to do a separate H&P or separate F/U >>hospital visits or F/U office visits. All those are already paid for in >>conjunction with the first procedure and its "global period". >> >>Don't yell at me! I am not saying I agree with this ... >> >>Joanne >> >>At Fri, 15 Mar 2002, jkulkin-whra wrote: >>> >>>I can think of no justification for the payer to do this. No done through >>>the same incision, not an incidental procedure. Separate liability for >>>complications and failure. >>> >>>Sounds like one for the insurance commissioner or consumer advocates offcie. >>> >>>JK >>> >>>Jay M. Kulkin, MD MBA FACOG >>>Women's Health Resource Associates >>>3475 Oak Valley Road >>>Suite 2640 >>>Atlanta, Georgia 30326 >>>404-841-0034 >>>Fax: 404-841-0054 >>> >>-- >>Joanne Bulley, MD >>Keene, NH, USA >> >>~*~ let there be peace on earth and let it begin with me ~*~ >> >-- >art fougner, md >ich bin ein New Yorker > -- Garry E. Siegel, M.D., F.A.C.O.G. Roswell, GA Private Practice Next message: Garry Siegel: "OB: Arrest of Dilatation/VBAC/post LEEP" Previous message: art fougner, md: "Re: Blues paying 'second procedure' for Postpartum t/l" In reply to: art fougner, md: "Re: Blues paying 'second procedure' for Postpartum t/l" Next in thread: Kevin Dew: "Re: Blues paying 'second procedure' for Postpartum t/l" Reply: Kevin Dew: "Re: Blues paying 'second procedure' for Postpartum t/l"

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