I just want to share with everyone a patient complaint I received yesterday.
The patient doesn't want to pay for the office consult with one of my surgeons because he told her he doesn't do the surgery she needs and set her up for an appointment with a surgeon that does. The supervisor taking the complaint brought it to me to determine if the coding was correct before she enforced that services were rendered and there is nothing we can do, sorry insurance didn't cover it (deductible).
I read the note, looked like a consult. PCP sends the patient to a surgeon for his opinion on how best to treat a chronic pain issue can they do surgery or not. Everything looked fine on our end.
As I did further investigation, I found out the PCP did not send the patient to us, the PCP sent the patient to a neurosurgeon who told the patient she didn't do that type of surgery. Neurosurgeon didn't send her anywhere she just said sorry I can't help you. On her own the patient starts calling all the surgeons she can find in the hospital directory and ends up calling one of mine. She asked the office staff if the doctor "takes out ribs", the staff told her yes he does he can do your surgery. They make her an appointment. And as earlier stated my doctor documented this like a consult, sent copies of the notes to the PCP, the neurosurgeon, and the doctor he sent the patient to after him.
This was not a consult. This is a specialist who thinks he is entitled to bill for consults because he is a specialist. I don't dispute the patient received services and does owe a balance, but consults cost more than new patients and I feel it should be dropped down to the appropriate new patient code and sent back to the insurance for reconsideration which is what I advised them needs to happen.
This upsets me as both an auditor and a patient. It is very frustrating when I hear people make statements like "you can't be held responsible for other doctors documentation, if you document you did a consult they have to pay you for it". We wouldn't advise them to document additional elements of exam that didn't take place, or anything else for that matter. At least I hope no one would. So why would we advise them on how to make it look like a service it wasn't?
I only advise them to document what they do and I am crossing my fingers the consults go away because I feel like I am in the minority when it comes to wanting to do it right not just make it look right.
Laura, CPC, CEMC