Author Topic: Surgeon's initial office visit was $215  (Read 1132 times)

venustasis

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Surgeon's initial office visit was $215
« on: October 27, 2011, 08:47:28 PM »
I am a medical provider.  I am very aware of the aspects of what should be included in an office visit to charge a certain amount. I refer patients to this plastic surgeon weekly, but now I will not.  I consulted him for his opinion of the breast implants I received 25 years ago.  I am having NO problems, just wanted his opinion.

I was face to face with him for 20 minutes.  No vitals were taken, no ROS was taken, the only physical exam was of my breasts, he did take pictures.  I have a professional relationship with this physician, but feel strongly this is an exaggerated charge. I have a high deductible insurance plan, so I am responsible for the $215 charge

Do you feel like this is a valid complaint I should pursue?
Please reply!

PMRNC

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Re: Surgeon's initial office visit was $215
« Reply #1 on: October 28, 2011, 06:29:18 AM »
To me it sounds like a valid complaint, and I would say it would be if he did not meet the elements of the E/M code to which he billed.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

venustasis

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Re: Surgeon's initial office visit was $215
« Reply #2 on: October 31, 2011, 07:47:44 PM »
Thanks for the reply.

Do you have a hint as to how this valid complaint be pursued?  Should I speak to the billing clerk, office manager, the physician? (I have a professional relationship with this doc).

PMRNC

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Re: Surgeon's initial office visit was $215
« Reply #3 on: November 01, 2011, 06:04:08 AM »
I'd start with the billing clerk and find out how the claim was coded and work from there. Good possibility that the provider didn't code it. Request that it be looked at again to be sure the appropriate code was used. This may not be a mistake by the provider but rather on the part of the biller or coder. If they still insist it's correct ask for the medical record from the visit and an itemized (coded) bill and take a look to be sure that the E/M used has met all criteria from the medical record. 
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com