Bilateral procedure coding

[smarterchild]

Hey guys. I know billing for bilateral procedures will result in A 50% reimbursement for the other side. Does this also apply to j codes?

I have a patient who would like bilateral synvisc one injections. I just want to make sure I don’t get short-changed on the synvisc j code. Otherwise I’ll have to ask the patient to make two separate appointments as synvisc is very expensive around here ($1500 per knee) from my suppliers and it’s the only gel his insurance covers.

Thanks

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[gdub25]

We always do one side at a time.

 

[BobBarker]

I do sv1 and gel one, one side at a time. I have one patient that United demands euflexxa. I did both those at the same time. Much cheaper mistake if it doesn’t work out. I did call a joint ortho before and he said you would capture both units on the j codes. Just take the 50% reduction on the second side for the procedure code.

 

[smarterchild]

Thanks all!

As an aside, the patients insurance only covers 80% of the gels. Do you typically require prepayment of this amount before you order the gel or do you allow patients to pay on the day of the procedure?