Coding > Coding
Charging attorney for office visits
lherron:
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:
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.
Michele
lherron:
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:
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:
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!
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