Multiple Endoscopy-Pay Percent


As announced in June, The Multiple Endoscopy-Pay Percent is a new policy. We now edit endoscopic procedure codes billed to align with CMS guidelines. Edits will apply to multiple endoscopic procedures performed for the same patient, by the same provider, on the same date of service. The editing rules will, for example, look for multiple endoscopies billed, determine when multiple base procedure codes in the same family are incorrectly billed, and apply the multiple procedure cutback. The Relative Value Unit will be used when calculating the multiple endoscopy reduction. In addition to an adjustment based on the multiple endoscopy and multiple surgery guidelines, adjustments may also be made based on the following concepts: Bilateral, Multiple Quantity, and Payment Modifiers.