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Compliance Issue?

  1. #1
    Default Compliance Issue?
    Medical Coding Books
    Patient presents for debridement & dressing of burn.

    Physician wants to charge a 99212, however there is a code for debridement & dressing that applies- 16020. I added 16020 and did not charge an E&M. Now the physician has come back to me stating he does not want to charge the procedure code, only an OV because the patient is self pay.

    I've been told that if I can pull info out to meet a 99212 then to charge it and not the procedure. My question is compliace wise is this okay to do? I feel uneasy charging an E&M when I know there is a procedure that was performed. I feel like if the physician doesn't want to charge the patient for the procedure (because the pt is self pay) then he should just no charge the visit all together.
    Does anyone know the exact rule on charging an E&M rather than a procedure when a procedure is performed? It seems fraudulant to me.....

  2. #2
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    Quote Originally Posted by Reece04 View Post
    Patient presents for debridement & dressing of burn.

    Physician wants to charge a 99212, however there is a code for debridement & dressing that applies- 16020. I added 16020 and did not charge an E&M. Now the physician has come back to me stating he does not want to charge the procedure code, only an OV because the patient is self pay.

    I've been told that if I can pull info out to meet a 99212 then to charge it and not the procedure. My question is compliace wise is this okay to do? I feel uneasy charging an E&M when I know there is a procedure that was performed. I feel like if the physician doesn't want to charge the patient for the procedure (because the pt is self pay) then he should just no charge the visit all together.
    Does anyone know the exact rule on charging an E&M rather than a procedure when a procedure is performed? It seems fraudulant to me.....
    I think that the charges should be billed just because they have been performed and documented regardless what kind of insurance patient has. You can charge 16020 and change the price to make it easier for self pay patient to pay. You would do what is right from your stand point and at the same time not charge patient more than the Dr wants

  3. #3
    Default
    Quote Originally Posted by Reece04 View Post
    Patient presents for debridement & dressing of burn.

    Physician wants to charge a 99212, however there is a code for debridement & dressing that applies- 16020. I added 16020 and did not charge an E&M. Now the physician has come back to me stating he does not want to charge the procedure code, only an OV because the patient is self pay.

    I've been told that if I can pull info out to meet a 99212 then to charge it and not the procedure. My question is compliace wise is this okay to do? I feel uneasy charging an E&M when I know there is a procedure that was performed. I feel like if the physician doesn't want to charge the patient for the procedure (because the pt is self pay) then he should just no charge the visit all together.
    Does anyone know the exact rule on charging an E&M rather than a procedure when a procedure is performed? It seems fraudulant to me.....
    Fraud, in the context that you're thinking, isn't technically applicable to self-pay patients - there aren't any laws governing what physicians can and can't charge, when no claims are involved. He can bill them whatever amount he wants, if they're in a financial need. I've seen a lot of providers that do this - that doesn't make it correct, but it's common.
    From a liability standpoint, though, he's better off billing the correct service, and providing a discount to equal the amount he wishes to charge. It's always better to have the billing record reflect the actual services provided, in the event that the patient ever decides to sue him for malpractice. But, no, he shouldn't be at risk of getting in trouble for fraud, for that.

  4. #4
    Default
    Thank you!

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