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DRG and how surgical specialties get paid?

firewicket

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7+ Year Member
Nov 13, 2012
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Reimbursement question:
If hospital is reimbursed with a DRG for an admission...say PNA...but pt has metastatic cancer (for example) and Also needs an internal fixation/prophylactic femur nailing.

How does the private practice orthopedic doctor get paid?

Same question goes for inpatient radiation. If hospital is simply given a DRG lump sum...how is a private practice professional fee doctor reimbursed off this?
 

medgator

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15+ Year Member
Sep 20, 2004
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  1. Attending Physician
Reimbursement question:
If hospital is reimbursed with a DRG for an admission...say PNA...but pt has metastatic cancer (for example) and Also needs an internal fixation/prophylactic femur nailing.

How does the private practice orthopedic doctor get paid?

Same question goes for inpatient radiation. If hospital is simply given a DRG lump sum...how is a private practice professional fee doctor reimbursed off this?
Pro codes still can get billed by whoever, ortho, rad onc etc but technical comes out of drg.

Only applies to standard Medicare drg situations i believe, not the case with Medicare advantage, Medicaid or commercial afaik
 
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