Q&A: Billing for cosmetic and covered procedures

Wednesday, February 7, 2024

Q: How do you bill operating room (OR), anesthesia, and recovery time for cosmetic and medically necessary procedures performed during the same encounter?

A: Typically, the OR time for each procedure would be documented in the medical record. I have seen this as noted in the section where the OR time is documented or in the circulator notes. Then, the time is billed accordingly based on the medically necessary procedure and the cosmetic procedure.

The anesthesia time would follow the same time parameters as the individual procedure. [An option I have experience with is to] prorate the recovery time based on the amount of OR time for each procedure. For example, if the medically necessary procedure was 75% of the total OR time, then we billed 75% of the recovery time and the rest to the cosmetic surgery. [The organization] had a policy that said this was our process.

Editor’s note: This question was posted on the NAHRI Forums and answered by  NAHRI Advisory Board member Denise Williams, COC, CHRI. Opinions expressed are those of the authors and do not necessarily represent those of NAHRI, HCPro, or any of its subsidiaries. Find more NAHRI resources on billing and claims here.