07/19/2019 – PROPER REPORTING OF UPPER VS. LOWER ABDOMINAL FOR PROPER REIMBURSEMENT.

Are you getting the full reimbursement allowed for your abdominal procedures?

 

Question: Why is it important to document upper vs. lower abdomen? Does it really make a difference?

 

Answer: It is very important to mark or indicate whether the work was performed either in the upper or lower abdominal quadrants. While some procedures are the same base unit for upper vs. lower abdominal procedures, most have a base unit difference of 7 (upper) vs. 6 (lower). Per coding guidelines, if any work was performed in the upper quadrants (exempt from this is the placement of trocars) then the upper ASA applies yielding the maximum base units for the procedure.

 

*Often operative reports do not specify where the work was performed and can yield in loss of base units if the proper documentation is not provided. In addition, making notes of the proper location where the work was performed ensures proper billing compliance and will limit issues regarding audits.


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