MO HealthNet Internet

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• MO HealthNet Internet
• Provider Training Program
• Presented by the Provider Education Unit
• MO HealthNet Division

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MULTIPLE SURGICAL PROCEDURES

• Presented by the Provider Education Unit
• MO HealthNet Division

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• Information regarding multiple surgical
• procedures can be found in Section 13.40.F
• of the Physician Provider Manual. To access
• the manual go to the MHD Public Web site
• www.dss.mo.gov/mhd/providers/index.htm.
• In the left hand column, click on Provider
• Manuals.

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• When multiple surgical procedures are
• performed for the same body system
• through the same incision, the major
• procedure is considered for
• reimbursement at 100 of the allowable
• fee for the procedure.

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• Multiple surgical procedures performed on
• the same participant, on the same date of
• service, by the same provider, for the same
• or separate body system through separate
• incisions must be billed as follows
• The major, secondary and tertiary procedures
  should be indicated on the claim form using
  appropriate CPT codes.

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• A copy of the Operative Report must be
• attached to the paper claim for multiple
• surgeries to provide additional
• information and to assist in the
• reimbursement process.

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• Claims for multiple surgeries are allowed
• according to the following
• 100 of the allowable fee for the major procedure
• 50 of the allowable fee for the secondary
  procedure
• 25 of the allowable fee for each additional
  procedure

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• An exception to the multiple surgical
• procedure policy is diagnostic
• endoscopies.
• When more than one diagnostic endoscopy
• is performed on the same day with the same
• or different approaches, but different
• instruments, both are reimbursable at 100
• of the allowable fee for the procedure.

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• When more than one diagnostic
• endoscopy is performed on the same
• day using the same approach and the
• same instrument, only the major
• procedure is reimbursable.

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• Thank you again for participating in
• this training program. If you have
• questions regarding the information
• in this presentation, please contact
• the Provider Education Unit at
• 573-751-6683.