Author Topic: Undercoding?  (Read 131 times)


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« on: July 11, 2018, 11:44:39 AM »
If a physician sees a patient for their routine obstetric care and does an ultrasound each time  for no medical reason other than the patient wants one or expects to have one every visit is this under coding If the physician does not bill it to the insurance? The physician has stated he does not want the patient to incur  costs for these ultrasounds so they donít bill them and just waive the ultrasounds.

Keep in mind there is no E/M code billed out because these are routine visits.


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Re: Undercoding?
« Reply #1 on: July 11, 2018, 11:48:14 PM »
The simple way to look at this is that medical necessity is the overarching criterion for any service that is billed to insurance. So if there is no medical necessity for a service performed, then that service should not be billed to insurance. The cost incurred to the patient is not the concern, even if the doctor feels that it is. If these U/S's are not medically necessary, then they should not be billed to insurance, and if the doctor wants to eat the cost of doing them, that is their choice.

Under-coding is something else entirely... for example: Performing a medically necessary procedure and just billing an E/M code, or performing a higher level E/M code such as a 99214, and reducing it down to a 99212, for instance.