ARCPC9491
True Blue
Okay here goes........
I have a situation where a patient came in for an elective abortion. The doctor had coded out himself a 99205 and the abortion CPT. The insurance did pay for both. The patient paid her $40 copay and the coinsurance ended up being like $35.00 or something.
Anyway, the patient got the bill and called the billing staff irate that she had been charged an E/M code, she stated she was in coding herself and knew that 99205 was not appropriately billed because 1) she never saw the doctor face to face 2) the doctor knew why she was coming in so therefore an E/M would be inappropriate and 3) her condition in no way would have warranted a level 5. She told the staff that she wanted a refund for her copay and to have the insurance reprocess it as if it were never billed.
Now, they're calling me and asking what they should do. I guess the physician was asked before me and he told the billing staff that "he did see her face to face, she was under anesthesia, he did the exam" He told them don't refund the copay, don't have insurance reprocess, and just to write off the coinsurance.
This is kind of awkward and I'm not quite sure what to tell them.
I personally think the use of the E/M was inappropriate. It seems unethical to bill an E/M when the patient is under anesthesia for an elective procedure.
Opinions??
I have a situation where a patient came in for an elective abortion. The doctor had coded out himself a 99205 and the abortion CPT. The insurance did pay for both. The patient paid her $40 copay and the coinsurance ended up being like $35.00 or something.
Anyway, the patient got the bill and called the billing staff irate that she had been charged an E/M code, she stated she was in coding herself and knew that 99205 was not appropriately billed because 1) she never saw the doctor face to face 2) the doctor knew why she was coming in so therefore an E/M would be inappropriate and 3) her condition in no way would have warranted a level 5. She told the staff that she wanted a refund for her copay and to have the insurance reprocess it as if it were never billed.
Now, they're calling me and asking what they should do. I guess the physician was asked before me and he told the billing staff that "he did see her face to face, she was under anesthesia, he did the exam" He told them don't refund the copay, don't have insurance reprocess, and just to write off the coinsurance.
This is kind of awkward and I'm not quite sure what to tell them.
I personally think the use of the E/M was inappropriate. It seems unethical to bill an E/M when the patient is under anesthesia for an elective procedure.
Opinions??
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