Problem oriented service during annual physical?

news

Hi,

I have a question related to the billing of my most recent annual physical. My health insurance provides a free annual physical every year. And I have had free annual physical for the past several years.

However, this year, I did the annual physical at a different hospital (which is still in network), and they coded the visit as Office Visit – new patient – 99203 (CPT®), which caused a $50 out-of-pocket patient responsibility. The agent from the provider said that

“a problem focused office visit is billed in conjunction with a preventative visit”, and “The diagnosis attached to the office visit charge is M54.2 – Cervicalgia, J30.9 “PT EVAL & TREAT (DMG), Allergic rhinitis “Recommend Claritin 10 mg daily and add Flonase 2 sprays each nostril daily”, D72.819 – Decreased white blood cell count, Z72.0 – Tobacco use, and G24.9 – Dystonia “Patient uses half tablet of carbamazepine daily. “

At receiving the response, I was very upset, because most diagnosis were from my medical history. And I told the doctor because she asked me about my history. How can she took those as her credit? Then I posted my comment, I received the reply from the provider:

“In addition to the annual health assessment, the patient has several other concerns to address”. If you would like to know what those concerns are you can request your medical record.

A preventative visit does not include prescription management, referrals, testing, discussion of new or existing health problems or symptoms. A preventative visit is a very general visit that may include a physical exam, blood pressure, height, weight, temperature and select immunizations. The doctor entered a referral for physical therapy to evaluate and treat your neck pain.

The charge is correct. “

I admit that I did talk about the neck pain issue, and the referral of the physical therapy is true. The process is like:

  1. t the last of the annual physical, the doctor asked about any other issue?
  2. I told her that I had a neck pain, because I wanted gave all information I had so the doctor could help me.
  3. She asked about details, and gave me a referral to a physical therapist.

I am still confused, and can not be convinced with the explanation of the billing. I really appreciate it if anyone could answer my questions:

  1. Is it reasonable for the provider to code my annual physical to problem focused visit due to the “neck bone” referral?
  2. Is it reasonable for the provider to count my existing/diagnosed medical issues as part of the problem focused service.
  3. If not, how can I argue with them to correct the billing.
  4. If so, how can I avoid this kind of unexpected charging in an annual physical? I mean, I know the doctor is not in responsibility of the coding, and I can not confirm the charging of every step during a visit.

Thanks,

submitted by /u/onegiantpanda
[link] [comments]
Hi, I have a question related to the billing of my most recent annual physical. My health insurance provides a free annual physical every year. And I have had free annual physical for the past several years. However, this year, I did the annual physical at a different hospital (which is still in network), and they coded the visit as Office Visit – new patient – 99203 (CPT®), which caused a $50 out-of-pocket patient responsibility. The agent from the provider said that “a problem focused office visit is billed in conjunction with a preventative visit”, and “The diagnosis attached to the office visit charge is M54.2 – Cervicalgia, J30.9 “PT EVAL & TREAT (DMG), Allergic rhinitis “Recommend Claritin 10 mg daily and add Flonase 2 sprays each nostril daily”, D72.819 – Decreased white blood cell count, Z72.0 – Tobacco use, and G24.9 – Dystonia “Patient uses half tablet of carbamazepine daily. ” At receiving the response, I was very upset, because most diagnosis were from my medical history. And I told the doctor because she asked me about my history. How can she took those as her credit? Then I posted my comment, I received the reply from the provider: “In addition to the annual health assessment, the patient has several other concerns to address”. If you would like to know what those concerns are you can request your medical record. A preventative visit does not include prescription management, referrals, testing, discussion of new or existing health problems or symptoms. A preventative visit is a very general visit that may include a physical exam, blood pressure, height, weight, temperature and select immunizations. The doctor entered a referral for physical therapy to evaluate and treat your neck pain. The charge is correct. ” I admit that I did talk about the neck pain issue, and the referral of the physical therapy is true. The process is like:
t the last of the annual physical, the doctor asked about any other issue? I told her that I had a neck pain, because I wanted gave all information I had so the doctor could help me. She asked about details, and gave me a referral to a physical therapist.
I am still confused, and can not be convinced with the explanation of the billing. I really appreciate it if anyone could answer my questions:
Is it reasonable for the provider to code my annual physical to problem focused visit due to the “neck bone” referral? Is it reasonable for the provider to count my existing/diagnosed medical issues as part of the problem focused service. If not, how can I argue with them to correct the billing. If so, how can I avoid this kind of unexpected charging in an annual physical? I mean, I know the doctor is not in responsibility of the coding, and I can not confirm the charging of every step during a visit.
​ Thanks,
submitted by /u/onegiantpanda [link] [comments]Read Morer/HealthInsurance

Leave a Reply

Your email address will not be published. Required fields are marked *