Author Topic: outpatient treatment?????  (Read 2252 times)

dhelgert

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outpatient treatment?????
« on: February 29, 2012, 10:03:01 PM »
My daughter recently had an eeg done and it came up with some abnormalities. The neurologist who gave her the test wanted to put her on medication. Before giving her medication I needed a second opinion so I scheduled one through childrens hospital. This doctor was going to read my current eeg results and give me a second opinion. There were some issues on getting the results and I didn't have them at the appointment. No second opinion was given yet but the facility is billing my insurance as outpatient. My insurance recognizes out patient as a surgery and it goes towards my deductible.  My question is, is there any way this can be billed as an office visit. All it was was a consultation and no treatment was given. I am being told because their office is in a hospital it needs to be billed as an outpatient treatuhment. Please help!!!

PMRNC

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Re: outpatient treatment?????
« Reply #1 on: March 01, 2012, 06:47:17 AM »
Quote
No second opinion was given yet but the facility is billing my insurance as outpatient. My insurance recognizes out patient as a surgery and it goes towards my deductible.

You don't say exactly what was billed, a CPT would help.   Also on the consult you went for for the 2nd opinion, did they put 2nd opinion on claim because many insurance plan's cover 2nd opinions at 100% no out of pocket.  But again, it's hard to see if they did anything wrong without knowing exactly what was billed out.
Linda Walker
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dhelgert

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Re: outpatient treatment?????
« Reply #2 on: March 01, 2012, 08:33:57 PM »
The code that was sent to the insurance was 99245. Is there any code to describe this appointment as a second opinion. Is there any way for them to bill this as an office visit, my insurance seems to pay much more when it is billed as an office visit. Thankyou very much for such a quick response!!!!

rdmoore2003

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Re: outpatient treatment?????
« Reply #3 on: March 02, 2012, 12:07:50 PM »
The description for 99245 is Office consultation for a new or established patient.  Is the provider networked with your insurance?  If so, is provider set up as professional office or as a facility with your insurance?
Regina

dhelgert

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Re: outpatient treatment?????
« Reply #4 on: March 03, 2012, 12:12:41 AM »
Yes the provider is in my insurance network. It seems he has no home office and does all of his work at a hospital. With there being no home office is there no way of billing as an office visit? This is the second doctor I am seeing for the possible condition is there any way of billing this as a second opinion?

PMRNC

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Re: outpatient treatment?????
« Reply #5 on: March 03, 2012, 08:26:04 AM »
Call them and remind them it was a 2nd opinion, but first you want to see if your plan covers the 2nd opinion, and at what benefit rate, I believe even if he's not in your network most plans have 100% coverage for second opinions but you should check. The doctor might be able to assist with sending in documentation for the 2nd opinion.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com