27786

[msmelissp]

Can someone tell me if this is a correct charge before I escalate the issue....My son was taken to Med Express and diagnosed with an aversion fracture, they put a soft cast on (removable) and told us to follow up with orthopedic Dr. The next morning. We went to the hospitals walk in clinic, took the x-ray disc from Med Express and they said yes, it was in fact an aversion fracture and put him in a boot. No other xrays, didn't even touch his ankle but was charged $566.00 for office visit, code 99204 and an additional charge of $932.50 for code 27786-surgery. My part of the bill, after insurance paid was$556.27. Seems like alot and when I saw "surgery" I thought, this is misleading. I questioned the office manager and she just said "its a charge we have for all fracture patients and it covers 3 months of care" But I still got another bill for the boot $220. We have had one followup visit and I haven't received an EOB but it may not have  been long enough for billing since it was the Holiday's.  Is this something I should accept and pay or dispute the charge? Thanks for all your help. I don't want to cause anyone any trouble but don't want to pay for something that I shouldn't.

[Michele]

I'm assuming you have a deductible and that is why your portion is so high.  As for the charges they do seem appropriate.  Since it was a first visit, never being seen before the 99204 is most likely appropriate.  The 27786 is considered surgery, even though the basically put a boot on your son.  The 27786 is for a "closed treatment" which means they did not have to open the skin to repair the fracture.  and the boot itself is a separate code and charge.  If they participate with your insurance, then your insurance carrier will specify what they allow for each of those codes.  As long as they didn't charge more than the insurance company allowed, the bill is correct.  If they don't participate with your insurance you could request some kind of discount, but there is no guarantee they can provide one.  If they do participate, they most likely cannot discount your bill as it may go against their contract with the insurance company.  Fractures can be quite costly.  I hope your son heals well.