Wiki removal of procedure code

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onamission

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scenario : pt came to er gastrostomy tube fell out v551 no other documentation by physician no hx no symptoms just the tube fell out he replaced gastrostomy tube confirmed with radiology film..... now bill goes out / medicare payment recieved / pt calls and says 2nd ins does not consider er visit emergent so they arent paying and pt gets billed. / pt calls to have chart reviewed billing requests review / pt had procedure done would you remove the procedure and rebill?
 
nope I would appeal the denial with medical rationale, such as the time of the encounter, why did the patient need to come to ER as opposed to their physician or an urgent care. You need to bill the encounter for the way it was.
 
nurses notes say hx of throat ca but dr never documents any hx or symptoms patient and husband thought it to be emergency / her ins says it could have been replaced in dr office
 
it was patient choice to come to the ER for a non emergent condition... if the physician office was open they could have called or they could have talked to an on call doctor. It is a shame I know that they will get "stuck" with the bill but that is how the system works.
 
i agree .....it should be billed the way it was coded. th reviewer looked at the chart and told billing that they removed the procedure because the reviewer states she feels it should be part of the e/m ... and they can bill to see if it would be less money wouldnt that be fraud especially if medicare already paid the claim.
 
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