There are many complex rules for billing multiple surgeries, for more information about billing multiple surgeries performed under the same anaesthetic go to Preamble B.9.e. of the MSC Payment Schedule. The following are some examples:
Similar procedures (including bilateral), or procedures performed in the same general area - Preamble B.9.e.i.)
The greater fee is paid in full; the lesser fees are paid at 50% unless otherwise listed in the Payment Schedule.
Incidental surgery performed en passant
Incidental surgery performed en passant in addition to another surgery is considered to be included in the fee for the planned procedure and may not be charged. "Incidental surgery" is defined as surgery that would not have been performed in the absence of the definitive procedure.
|Example 1:||Appendectomy with other abdominal procedures is not billable unless significant pathology of the appendix is present. When billing appendectomy or other surgery that may be considered incidental, please provide the medical indication in your note record or provide the operative report.|
|Example 2:||When an exploratory laparotomy leads to a definitive surgical procedure through the same incision, only the definitive procedure can be billed (i.e. no additional charge should be made for the laparotomy).|
Different procedures performed through separate incisions - (Preamble B.9.e.ii.)
When different procedures are performed through separate incisions (other than bilateral procedures), and repositioning or redraping of the patient for more than one surgical site is required, the greater fee is paid in full and the lesser fee(s) are paid at 75%. Otherwise, the greater fee is billable in full, and the lesser fee is billable at 50%, in accordance with Preamble B.9.e.i).
This Preamble only applies to separate incisions, and does not apply when extending a single incision to access a separate operative site.
Procedures listed as "extra" - (Preamble B.9.e.iii)
Surgical procedures that are listed as "extra" in the Payment Schedule can be billed at the full listed fee even when performed with other surgical procedures, unless otherwise indicated in the Payment Schedule.
Multiple procedures performed by two or more surgeons - (Preamble B.9.iv and B.9.v)
Where specific team fees exist in the Payment Schedule for the procedures performed, bill under the appropriate listed items.
When two surgeons are performing an Abdomino-perineal resection, the correct team fees are as follows:
- Abdomino-perineal resection - synchronous abdominal portion
When two procedures are performed under the same anaesthetic by two surgeons and both procedures are within the competence of either one of the operators, the total surgical fee claimed should be no more than that which would be payable if both procedures had been performed by one surgeon, plus one assistant's fee.
|Example:||If two general surgeons were operating under the same anaesthetic, with one performing a cholecystectomy and the other performing a hernia repair, bill as if one surgeon had done both procedures. Each of these procedures would be within the competence of either surgeon. Therefore the surgeon performing the procedure with the greater value can bill at 100%, and the surgeon performing the procedure with lesser value can bill at 50%.|
When two procedures are performed under the same anaesthetic by two surgeons whose different specialty skills are required, each surgeon can claim his/her specific services in full. These surgeons can bill an assistant's fee for assisting each other in addition to the surgical fees only when the surgical procedures are consecutive, rather than concurrent.
|Example:||If a Urologist performed a retropubic operation for urinary incontinence (fee item 08283), and a Gynaecologist performed a cystocoele and/or urethrocoele repair (fee item 04227) under the same anaesthetic, each surgeon can bill in full. If the procedures are done consecutively, each surgeon can also bill the applicable assistant's fee if they assist each other. If the procedures were done at the same time, the surgeons can not bill assistants' fees.|
Iatrogenic (intra-operative) injury - (Preamble B.9.e.viii)
Additional surgery performed to correct an intra-operative injury resulting from the complicated nature of the disease or significant pathology can be billed at 50% if performed by the same surgeon. If another surgeon performs the repair, it can be billed at 100%. All such claims should be billed with supporting information in a note record or operative report.
Laparoscopy in conjunction with other surgical procedures
Some laparoscopic procedures are now specifically listed in the MSC Payment Schedule (for example, fee item 07707 - Cholecystectomy - laparoscopic). Bill the specific laparoscopic fee where one exists. No additional charge can be made under fee item 04001 (Laparoscopy). When no specific fee exists for laparoscopic surgery, bill under the appropriate miscellaneous code in equity with the equivalent fee for the open procedure. When billing under a miscellaneous code, details must be provided in your note record, or a copy of the operative report.
When a surgical procedure is performed through the laparoscope, no additional charge can be made under fee item 04001 (Laparoscopy) unless specifically stated in the MSC Payment Schedule.
When a surgical procedure is attempted via laparoscope, and is subsequently converted to an open procedure, the laparoscopy can be billed under fee item 04001 at 50% unless a specific fee exists for this scenario, or is otherwise prohibited by the MSC Payment Schedule. Your billing must reflect that the proposed laparoscopic procedure was abandoned and converted to an open procedure. This information can be provided in a note record, or in the operative report.