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Need clarification in LOA and internal hernia repair

Margaret Posted Tue 01st of March, 2011 17:02:47 PM

I need clarification as to whether it is acceptable to only bill out the LOA as opposed to the hernia repair? I was taught to only bill out the internal hernia repair and not the LOA, however, my physician would like me to bill out the LOA only and not the hernia repair, which is unlisted.

Thanks in advance for your help!

SuperCoder Answered Tue 01st of March, 2011 18:00:50 PM

I think the physician is advising this because of his past experiences with Reimbursemet hurdles or reduced reimbursement problems as usually happens in these cases. And if you are billing an unlisted code, then physician will be more inclined to code for LOA rather for reimbursement scenario.

But the best bet is to Code for the appropriate procedure if you are billing an unlisted code, bill it with modifier 22, and with a comparison code of the equivalent level of procedure and fee value.

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