Selina Posted Tue 26th of June, 2018 07:52:42 AM
Hello, We have one payer that is suddenly applying the modified version of the Multiple Endoscopy Rule to our claims. (Rather than paying the full 100% for the highest valued procedure and 50% for the next, they pay the full value of the higher plus the difference between the next highest and the base code or adjusted allowable). We have 2 related questions....Are you able to confirm that this rule is still valid, and do you know which carriers are utilizing it? And, are you able to simplify the explanation of the payment calculation for the 2nd procedure? Thank you!
SuperCoder Answered Wed 27th of June, 2018 07:44:22 AM
The Multiple Endoscopy Rule is still the same, that is the most complex code is reimbursed fully, and the other codes are reimbursed as the difference between the code and the base endoscopy code. You may need to check with your payer abount modified version. Please feel to ask for any further query.