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Level 4 consult billed in error how to dispute

  1. Default Level 4 consult billed in error how to dispute
    Medical Coding Books
    I would like some help from any of you. We received a bill for a level 4 in patient consult. When my husband was admited the Dr wanted to perform a gastro endoscopy and endoscopy. My husband and I felt that was somewhat invasive and I asked the consulting Dr to call me. He went to the my husband's room the next am asking why he did not want this done. My husband told him it was too invasive there was no exam and the conversation lasted less than 3 minutes.
    I clearly told the attending nurse that we had no intention of having this procedure done and asked that the Dr call me in the am instead he went to see my husband.
    I have asked for all documents including progress notes, talked to the office manager at the physicians office advising her this is not a level 4 consult and I have notified the insurance company.
    My husband saw another Dr. Any hints on how I can get this to squash this bill can I write the Division of Insurance and advice of in appropriate billing.
    Do not want to see our credit suffer.

    Thank you,

  2. #2
    Duluth, Minnesota
    Carol, I believe you're on the right track! ..(though it isn't going to be an easy one) keep up the fight. Make sure they're aware that YOU ARE AWARE and unhappy about the charge. Contact the hospital/clinic facility as well. Make sure they answer and prove to you that this service is what they claim it is. (go above the office manager). What did they say anway?,,.were they able to support those services? Let them know that he saw another provider, and what was that providers plan for care? (less invasive?) ..

    keep on them,... keep your insurance company involved also - don't let them forget you're fighting it!

    It would be nice to see the "note" that doctor wrote, I'd love to see how they justify a Level 4 consult. Care to post it? (names deleted of course) I'd love to score it out, just to see what level I come up with. (others too maybe) I know at times it may seem like "only 3 minutes", and it may very well have been - but often they do dictate a bit more. Of course they can't make up things, so it should support what your husband says was gone over. That being said, there are guidelines that need to be met before something can be called a "consult" AND criteria for the level 4 must be met as well!
    Donna, CPC, CPC-H

  3. #3
    Another thought- was there a requesting MD, or how did you come to see this dr? It can't be a consult if there is no 3R's

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