Study: Physicians May Spread Out Endoscopy Procedures to Avoid Payment Reductions Through Bundling

Some endoscopy physicians may deliberately perform endoscopies on different days to avoid bundling and the associated reduction of payment, according to an Internal Medicine News report.

Researchers identified 12,905 Medicare beneficiaries who underwent a colonoscopy and a diagnostic upper endoscopy procedure within 180 days of each other. While nearly two-thirds of the procedures were bundled, another one-third were separated from each other by a median of only 26 days. Around 30 percent of procedures not performed on the same day were separated by four or fewer days.

Lead investigator Hashem B. Serag, MD, said the lack of bundling was unlikely to be explained by clinical necessity. He said physicians may be making clinical choices motivated by financial concerns. While providing related endoscopic services on the same day is more convenient, efficient and cost-effective, Medicare pays less when two endoscopic procedures are reported for the same patient on the same day. For example, reimbursement for a diagnostic upper endoscopy is around $75 when bundled, but around $150 if reported independently.

Related Articles on Coding, Billing and Collections:
Texas' Northstar Surgical Center Contracts With UnitedHealthcare
AAPC: Prepare Now for Modifier PD
Only 22% of Payors "Fully Ready" to Support ICD-10

© Copyright ASC COMMUNICATIONS 2012. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.