Wiki Can you pick and choose what you bill?

[DrTomsFA]

Hey,

Is a physician required to bill for the services that he or she performs? Example: Established patient receives an injection ( 20550 ), an ultrasound (76882).

Is it possible to not bill the carrier the 20550 and do a 99213 instead since you cannot bill a OV on the same day you bill a procedure? Assume dx is the same for both.

Note* I am aware of the modifier 25. This question is strictly on the basis of if the physician is allowed to pick and choose not bill a carrier for a specific service he or she conducted.



Thank you for your time and help!

 

[podcoder70]

Good grief, absolutely not! Bill for what was performed. If you know it is not covered then it is CASH.

 

[thomas7331]

I agree, it would be incorrect coding and a misrepresentation services to do this. If your physician was audited and the documentation reviewed, it would be clearly seen that the claim that was filed was inaccurate, and if it had resulted in an overpayment the payer would recover the funds and potentially view this as a fraudulent behavior.