Medical Billing Forum
Payments => Patient Billing => : cfobilling January 13, 2010, 12:07:48 PM
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Ok so I do Orthopedic billing. When a child comes in with a fracture that needs follow up treatment and casting we use a global code. Sometimes when a global code is used it will be applied toward the members deductible. The member will them get the EOB and insurance companies consider global codes for treatment of fracture "surgery". Therefore it will like "surger" on the members EOB. I contactly have members calling me yelling because their child "did not have surgery" and insurance companies tell the members that we billed as if the child as surgery and that we should bill differently. Any advise on how I can explain this to members? I've tried every which way but all they see is the "surgery" even though I explain to them that the code is for closed treatment of a fracture w/o manipulation.
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Very common problem actually. The billing is correct. Sometimes it helps if it is explained to the patient/parent at the time of the casting that "the insurance carriers consider treatment of a fracture a surgical procedure, even though it doesn't appear to be surgery. So don't be surprised if your eob reads 'surgery'". Sometimes it helps if you just tell them BEFORE they get the EOB instead of after.
Michele