CMS Pub. 100-04, ch. 4, § 180.2

A-01-50, A3-3626.4.B.3

Using medical records as basic sources, hospitals report HCPCS surgical procedure codes

for outpatient surgery in FL 44 adjacent to the revenue code for the operating room or

other room used for the surgery. The bill includes the hospital’s charges for the surgery

as well as all other services provided on the day the procedure was performed.

When multiple surgical procedures are performed at the same session, it is not necessary

to bill separate charges for each procedure. It is acceptable to bill a single charge under

the revenue code that describes where the procedure was performed (e.g., operating

room, treatment room, etc.) on the same line as one of the surgical procedure

CPT/HCPCS codes and bill the other procedures using the appropriate CPT/HCPCS code

and the same revenue code, but with “0” charges in the charge field.

In the past, some hospitals billed a single emergency room (ER) visit charge, which

included charges for any surgical procedures that were performed in the ER at the time of

the ER visit. Under the OPPS, CMS requires hospitals to bill a separate charge for ER

visits and surgical procedures effective with claims with dates of service on or after July

1, 2001. If a surgical procedure is performed in the ER, the charge for the procedure

must be billed with the emergency room revenue code. If an ER visit occurs on the same

day, a charge should be billed for the ER visit and a separate charge should be billed for

the surgical procedure(s) performed. As described above, a single charge may be billed

for all surgical procedures if more than one is performed in the ER during the same

session.

EXAMPLE: The following is an example of how a claim should be completed under

these reporting requirements:

Date of

Service

Revenue

Code

HCPCS Modifier Charges

7/5/2001 0450 99283 25 $150

7/5/2001 0450 12011 $300

7/5/2001 0450 12035

7/5/2001 0250 $70

7/5/2001 0270 $85

The charge for both surgical procedures in this example is reflected in the $300 charge

shown on the line with procedure code 12011.