Re: Billing question consults
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Sat May 10 03:07:24 2008
Right or wrong, because the rules regarding consults are such a pain, we
simpl decided not to worry about it and bill E and Ms.
FWIW, we generally separate E and M visits from procedure visits
whenever possible, and simply explain to the patients that most/all
insurers won't cover the biopsy (for instance) on the day of the problem
visit (i.e. I came in for abnormal bleeding at age 45) on the same day.
Thus, we're sorry that you must come back in a few days.
Virtually all understand and are OK with it.
We all know it is suboptimal for the patients, to say the least, but it
is just reality. We can't give away services whose payments are already
discounted, and we can't spend staff time calling and getting
authorization to proceed.
Garry
At Fri, 9 May 2008, Douglas Krell wrote:
>
>We're advocating two separate dictations plus a copy of both sent to the referring physician.
>A consultation visit is a distinct entity that requires a referring physician's name and letter sent
>back to the doctor with the recommendations. Most want you to evaluate and treat, and a separate
>procedure note documents that.
>
>--
>Douglas Krell MD
>
>Date: Fri, 9 May 2008 16:54:20 -0500
>From: RModugno@aol.com
>To: ob-gyn-l@mail.obgyn.net
>Subject: Re: Billing question
>
>Not having my book handy there is a "decision to do surgery modifier" and
>in the example quoted by Hank, then you could bill for both but as has been
>said- good luck on getting paid.
>
>Robert Modugno MD MBA FACOG
>Sylva, NC
>
>In a message dated 5/6/2008 10:34:41 P.M. Eastern Daylight Time,
>henrygregor@yahoo.com writes:
>
> Modifier -25 (Sigificant,separatelly identifiable E/M Service by the same
> physician n the Same Day of the Procedure of Other Service). For
> example, your scenario, or, a patient sees her physcian for vulvar pain and a
> Bartholin's abscess is diagnosed. If the physician performs an I&D,
> document the evaluation and diagnosis process separately, generally by
> creating a standard evaluation and diagnosis documentation note, followed by a
> separate procedure note. Then report, using the E/M code with a -25
> modifier.
>
> Be prepared to do persistent battle with the insuror. Some will
> cooperate, most won't. (I guess they depend on most providers and their
> billing staff to roll over, and move on to something else, like
> playing the float on their delayed payments.)
>
> Keep a careful data base of those who do, those who don't...eventually,
> you can spare yourself the agony of wasting time on those carriers who won't
> honor the modifier. I have found most patients are sympathetic to the analogy
> that if you go the supermarket and buy eggs and butter its reasonable for the
> store manager to want to be paid for both products and not just for the eggs.
> I have found most patients will come back on another day to have
> the procedure done, though, of course, for a symptomatic issue like the
> Bartholin's cyst, that may be too burdensome and you and the patient will
> probably want to do what needs doing then and there.Keep a handy printed
> reference to give the patient to send to her state insurance commissioner for
> consumer complaint if her carrier fails payment and the burden falls upon
> her.
>
>"Garry E. Siegel, M.D."
> <garrys@mindspring.com> wrote:
> If
> during the course of your evaluation, you determine the need for
> a
>procedure (an endometrial biopsy comes to mind), then you can bill
> the
>E/M AND the procedure, with a modifier, I think. Lots of
>
> luck
>collecting on it, however.
>
>That said, if someone came in for
> contraceptive counseling, and you
>decided to put in an IUD, I bet that
> you could code it similarly with
>the best of luck
> collecting.
>
>Garry
>
>At Tue, 6 May 2008, Lynn Montgomery
> wrote:
>>
>>Listers,
>>
>>I would like opinions
>
> regarding a billing question; when a patient
>>presents for an office
>
> visit for an IUD insertion or colposcopy for
>>example, is one allowed
>
> to bill an office visit in addition to the
>>actual procedure being
>
> performed (i.e. 99203 for office visit and 58300
>>for IUD insertion).
>
> I have gotten different answers from various
>>coders, including
>
> ACOG!
>>
>>Lynn
>>
>>--
>>Lynn D. Montgomery,
>
> M.D.
>>
>>Obstetrics & Gynecology, Maternal-Fetal
>
> Medicine
>>
>>The Birth Center/Rocky Mountain Women's
>
> Health
>>
>>1211 S. Reserve St.
>>
>>Missoula, Montana,
>
> 59801
>>
>>406-549-0978
>>
>>fax
>
> 406-549-0987
>>
>>e-mail:
>
> apgar10@thebirthcentermt.com
>>
>--
>Garry E. Siegel,
> M.D.
>Private Practice
>Roswell, GA
>
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>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
