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Re: ASC-USFrom: GORDON M. GOLDMAN (obgyndoc@swbell.net)Sun Sep 2 17:05:55 2007
Barbara Nicol <blnicol@ix.netcom.com> wrote: Oh, and if you do go ahead and do the extra pap, let me suggest not billing the insurance. If you look at your insurance contracts, I expect they say that you agree to provide medically indicated care, and bill them only for same. This doesn't fall under the category of "medically necessary", does it? You're doing the pap to treat anxiety - which isn't really the usual treatment for anxiety - and not for any well-studied, evidence based purpose. If she still insists on the pap, you should make it clear that it's not a medically indicated procedure, and she needs to take responsibility for the costs and risks. That should take care of your coding difficulty - if you don't bill an insurer, you don't need a diagnosis code. You just need to charge her your usual fee for this elective, medically unnecessary service, and collect payment (in advance, I might add), and have the lab do the same. Again, best of luck to you! - Barb Nicol, M.D.
> ----- Original Message ----- Sometimes I've done that - ASCUS pap smears cause a lot of anxiety - but other times, I've managed something even better - getting the patient to understand the limitations of the test. Usually have achieved this either by emailing them actual guidelines and papers(works pretty well with the college-educated) or sometimes by referring them for another opinion. If they hear the same statement from multiple voices, sometimes they actually start to believe what they're hearing. It also helps, sometimes, to continue explaining that dysplasia doesn't cause any symptoms, so it can't possibly be the cause of the pelvic pain, even if were there. Ultimately, this produces a better-educated patient. The media are full of "I made my doctor do the test and that's how I found my cancer" stories. I wish they'd start publishing the "I made my doctor do the test and I had complications from my unnecessary procedure and lots of extra expenses and I never really needed the test in the first place" stories, to give patients some of the perspective that we have. Good luck, Barb Nicol, M.D.
> ----- Original Message ----- often after I have explained my opinion...unless it is entirely unreasonable(not I hope my opinion...but their request)..then I will frequently comply with their request as graciously as possibly... saves my coronaries....and maybe my ass. and will frequently reassure the patient...???? frances wren
>----- Original Message -----
> At Sat, 1 Sep 2007, R. Berg wrote:
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