E/M Coding Alert - 2011 Issue 27
Reader Question: Know When Product Cost is Included in Surgery
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Article Overview
This reader question and answer article discusses reimbursement and cost reporting considerations for a urologic procedure when a special stent must be ordered separately. It is aimed at coding, billing, and practice management professionals who need to understand how setting of service can affect whether the cost is reflected in hospital reporting or physician payment. The article focuses on broad guidance related to supply costs, facility reporting, and office versus hospital payment context.
Why This Topic Matters
Understanding when a product cost is included in payment versus handled separately is important for avoiding missed reimbursement and improper patient billing. The topic is especially relevant when the same procedure is performed in different settings that have different payment structures.
Article Sections
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Question
The reader presents a billing scenario involving a specially ordered stent and asks how the cost should be handled.
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Answer
The response discusses general cost reporting and payment context for the procedure in hospital and office settings, along with related reimbursement considerations.
What You Will Learn
- How supply and product costs may be handled in a surgical billing scenario
- Why the setting of service can affect payment treatment
- How facility and physician payment context can differ for the same procedure
- What types of billing and cost reporting issues arise with separately obtained medical supplies
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Urology office staff
- Hospital revenue cycle professionals
Codes Discussed
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