Author Topic: Charging attorney for office visits  (Read 2572 times)

lherron

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Charging attorney for office visits
« on: May 24, 2010, 11:46:37 AM »
Im fairly new to coding and have run into a new situation in our office I'm hoping someone can help me with.

I have a question regarding pre-payment of patient office visits from an attorney's office.  We are quoting the attorneys a 99245 CPT CODE  for pre-payment of office visit.  The patient isn't using regular medical insurance they are going through the attorney office as part of a settlement from MVA.

My question what is our coding compliance requirements in a cash pay situation in regard to billing?  I'm inclined to code per what the dictation dictates whether we have collected a certain amount from the attorney or not and refund back to attorney any amount that they may have overpaid. 

In a cash pay/private pay situation are we required to follow coding guidelines and compliance?
If not are there any issues with setting up a different code specifically for this type of situtation?

Michele

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Re: Charging attorney for office visits
« Reply #1 on: May 24, 2010, 08:31:26 PM »
Are you asking if you have to bill the NF fee schedule amounts or if you can bill your regular fees?  Not sure I completely understood what you are asking.

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lherron

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Re: Charging attorney for office visits
« Reply #2 on: May 25, 2010, 10:46:25 AM »
It is complicated.  We don't take patients who only have attorney's in a third party MVA situation without any medical insurance as back up.  We will do evaluations at attorney request if they pre-pay.  We quote them the hightest level consult code (99245) and money is collected prior to the OV.  Some staff believe because there is no medical insurance involved we can charge what we quoted them for highest payment from attorney.  I tend to think we still need to be compliant and bill according to the level of dictation.  If it codes at a lower level then we would/should refund the attorney that amount.  I also feel if we are using consult codes for this attorney situation that they should adhere to the rules and guidelines that referring physicans have to follow in order to bill for consult code to include a written note from attorney asking for consult and a letter back from the consulting provider with expressed thoughts beyond what is documented in the chart note.

So the question staff posed was are we non-compliant when medical insurance isn't involved in this senerio.  Because we are using CPT consult codes I tend to think we are because of RVU etc... attached to those codes.   I'm wondering if there are other codes we could use that would fit this situation better?  Maybe a 99080, with a reason for visit "special exam for attorney"?  Any help would be appreciated, thank you in advance. 

DMK

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Re: Charging attorney for office visits
« Reply #3 on: May 25, 2010, 11:34:34 AM »
Sorry if I'm speaking out of turn, but the "pre-pay" thing is what bothers me.  It would be more appropriate to have a letter from the attorney requesting the consultation and report and some form of agreement to pay for that service. (Not a lien against settlement, because that can take years).

Then the doctor can appropriately code for the exam based on the complexity of the particular case and the length of the report (99080), which could be shorter or longer depending on the complexity.  A discussion between the attorney and the doctor ahead of time regarding fees for differing types of cases (not one in particular) could build an excellent working relationship that would benefit many patients, help the case, and be a good source of income for the doctor.




lherron

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Re: Charging attorney for office visits
« Reply #4 on: May 25, 2010, 12:13:57 PM »
No, your not speaking out of turn at all.   I am not comfortable with it either.  Sounds like I am on the right track heading toward the 99080 code rather than a regular consult code.  Thanks so much!

PMRNC

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Re: Charging attorney for office visits
« Reply #5 on: May 25, 2010, 07:52:27 PM »
I don't like it either.. Why doesn't the provider just get the attorney to give them a LOI (Letter of Intent) that's just as good.. pre-paying just doesn't sound right because they are pre-paying for services not rendered. I would say that you could do your cash fee schedule.  This also should be in the providers Policy and Procedures.. so if they have one (hope they do) that would be first place I look first.
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oneround

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Re: Charging attorney for office visits
« Reply #6 on: June 03, 2010, 04:28:58 PM »
As a compliance officer and coder I will give my best in opinion.

Regardless if you are accepting cash patients or patients with a carrier that you will bill, you will always code your claims according to the dictation provided, no ifs ands or buts!  So as long as you are doing this you are compliant with coding guidlines.  If the provider is doing the consult and the pt meets all of the three componets listed in any of your consults as new or established then you will bill your consult and get paid.  These consults require a face to face visit.

Your 99080 is for a special report that the physician completes and usually there is no face to face vist these could be forms such as insurance forms.  Doc, does not see the patient.

Code 99080 is intended to be used when a physician fills out something other than a standard reporting form, such as paperwork related to the Family and Medical Leave Act. This code does not apply to the completion of routine forms, such as hospital-discharge summaries. Also note that it would not be appropriate to submit 99080 in conjunction with 99455 or 99456, which are the codes for work-related or medical disability evaluation services. The descriptors for these codes explicitly state that they include "completion of necessary documentation/certificates and reports."

So, if you dr is providing face to face visits then you are compliant with your consults, bill away.  If provider is just providing documentation then bill your special report code 99080.

We have many attorneys that prepay at our clinics for their clients, no law against it, but we really advise of facilities against doing it because it can cause numerous credits and man powere to invest later down the line when/if we have to refund any overpayments.

Hope this helps.
Michael A. Reynolds, CPC, CCP-P, CPMB, OS
Project Manager
Corporate Compliance
Sharp HealthCare