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Lumbar Fusion and Billing

When a law firm is reviewing the past bills for a lumbar fusion surgery, there may bills from several providers with many differing codes and charges.

The basic charges for a lumbar fusion include:

  • Pre-operative assessment by the surgeon and also by a primary care physician to assess for fitness for surgery. This may include radiology, electrocardiography, laboratory testing, and office visits.
  • The next set of bills that may be found is a hospital in-patient bill, which may be a “charge-master” with many different hospital charges.
  • The anesthesiologist and neuromonitoring team will also each have a bill for services.
  • The surgeon and assistant surgeon will have bills for each code needed for the procedure.
  • Finally, there is post-operative care, including post-operative radiology, medications, therapy and equipment.

To learn more about the bills that are reviewed following this or any other medical care, call Dawn Cook and see how she can help you determine the correct codes and reasonable charges for the care.

References:

American Medical Association (AMA): CPT® (Current Procedural Terminology). (2018). Retrieved from https://www.ama-assn.org/practice-management/cpt-current-procedural-terminology

American Academy of Family Physicians. Retrieved from  https://www.aafp.org/

URC (Usual, Reasonable and Customary). Retrieved fromhttps://www.healthcare.gov/glossary/UCR-usual-customary-and-reasonable/

Centers for Medicare & Medicaid Services (CMS). Defining the Medicare Severity Diagnosis Related Groups (MS-DRGs), Version 34.0. (2016, October 1). Retrieved from https://www.cms.gov/ICD10Manual/version34-fullcode-cms/fullcode_cms/Defining_the_Medicare_Severity_Diagnosis_Related_Groups_(MS-DRGs)_PBL-038.pdf

Assistants at Surgery, American College of Surgeons 2018 guidelines of surgeries and need for assistant. Retrieved from http://bulletin.facs.org/2018/04/acs-releases-2018-update-to-the-physicians-as-assistants-at-surgery-report/#.WySbyqknZsM Global Surgery Booklet, describes the global period after surgery when physician additional charges are not allowed from https://www.cms.gov/Outreach-and-Education/…/GloballSurgery-ICN907166.pdf