Procedure and Visit on the Same Day

Minor Diagnostic and Therapeutic Procedures

Preamble D. 8

  1. If in the course of a visit for a specific complaint, one or more procedures are performed which are unrelated to the purpose of the visit (e.g. URI and laceration repair), the service having the largest fee may be claimed in full and the remaining service(s) at 50 percent of the listed fee(s), unless otherwise specifically indicated in the MSC Payment Schedule.

Billing Example:

A 35 year old patient presents in the office with a laceration to their hand and during that visit their blood pressure was rechecked, laboratory results were reviewed and prescription for medication was renewed. Physician can bill fee item 13610 (laceration) at 100%, 00080 (minor tray fee) at 100% and 00100 (visit) at 50%.

Tips:

Ensure that the diagnostic codes on billing accurately reflect the reason for the service.

Generic diagnostic codes such as 780 or 999 will be considered the same condition and claims will be refused.

To determine the service with the greatest value when a tray fee is applicable, the amount of the tray fee will be added to the value of the procedure fee in the calculation process.

This does not apply to the Emergency Medicine, Level emergency care fee items.

 

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Disclaimer: MSP Tutor is intended to provide a guide for physicians and medical office assistants in billing claims to MSP. For definitive information on fee-for-service fee item codes and amounts, consult the current MSC Payment Schedule. If a discrepancy exists between the information contained in MSP Tutor and the MSC Payment Schedule, the information in the Payment Schedule will prevail.