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11/20/2019
RESPONSES/COMMENTS (CODINGLINE) - PART 2
From: Name Withheld
I agree that unbundling is inappropriate. However, staging procedures is a result of insurance companies not paying for separate identifiably different procedures. For example, I recently performed an exostectomy for a patient with adjacent toe osteophytes causing interdigital pressure wounds. When we called the Horizon of Alabama insurance company for pre-authorization, we were informed the second procedure on a separate toe would not be paid at all and the first procedure had a 90-day global period.
I notified the patient that he would be responsible for payment for the second procedure, so he scheduled it for after the 90 day-period. Regrettably, he will have to take an additional day off from work. Similar rules apply for multiple matrixectomies on different digits, different feet, Novitas insurance. Patients are informed that they can stage it or pay for it. Guess which option is chosen?
Name Withheld
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