Wiki HELP! 2 surgeries on the same day...

[TJAlexander]

We have an established patient that has a new WC comp injury for which he will need surgery (wrist) and another long-standing issue (shoulder) that he also needs surgery on. The surgeries CAN be performed during the same operative session but are we able to bill 2 different payers? He wants the surgery for both injuries to be performed on the same day. The W/C claim will include the operative report of course so my first thought is that it isn't possible to do both but I wanted to get some outside advice.

Thanks!

 

[csperoni]

Unfortunately, I am replying not because I have the answer, but because I too am curious about this.
My gut instinct is that it would be possible, but very, very, very difficult.
For example, if the patient has an office visit, it's relatively simple to have 2 different notes - one for the wrist billed to WC and one for the shoulder billed to commercial insurance. However, with a surgery, even if you as the surgeon submit the different surgeries to each respective carrier, then what about anesthesia? Hospital facility?
I think what would need to take place is that all bills would first get submitted to commercial along with notes and explanation. Commercial should pay for the shoulder portion. Then submitted to WC as though secondary. WC should pay for the wrist portion.
Getting all the carriers and providers involved to understand might be rather difficult. Another wrench is that under HIPAA you would not be able to send anything related to the shoulder to workers comp. But the records are going to be all inter-mingled.
I'd love to hear anyone with experience in this area weigh in.

 

[TJAlexander]

Unfortunately, I am replying not because I have the answer, but because I too am curious about this.
My gut instinct is that it would be possible, but very, very, very difficult.
For example, if the patient has an office visit, it's relatively simple to have 2 different notes - one for the wrist billed to WC and one for the shoulder billed to commercial insurance. However, with a surgery, even if you as the surgeon submit the different surgeries to each respective carrier, then what about anesthesia? Hospital facility?
I think what would need to take place is that all bills would first get submitted to commercial along with notes and explanation. Commercial should pay for the shoulder portion. Then submitted to WC as though secondary. WC should pay for the wrist portion.
Getting all the carriers and providers involved to understand might be rather difficult. Another wrench is that under HIPAA you would not be able to send anything related to the shoulder to workers comp. But the records are going to be all inter-mingled.
I'd love to hear anyone with experience in this area weigh in.

My gut instinct tells me that this is correct. I advised our clinical staff to schedule separate surgeries to avoid any complications with reimbursement. This job gets complicated enough with regular surgeries!!!