SRS Doctor Crew: proper billing code for responding to messages?

fatmoocow

bored
OT Supporter
Aug 27, 2002
28,785
the intarweb
I sent my doc an email through their app basically saying, "the shit you gave me didn't work...what do?"

He replies back 7 days later on a Sunday with a two sentence email with incorrect information, obviously not looking at my chart. Phones in another prescription.

I then get a bill for $92 with a bill that's coded as a telehealth/video conference. They somehow fucked up my info when submitting to insurance so they sent me the whole bill as well, separate issue. Otherwise I wouldn't have caught it.


After I called them and asked wtf I'm getting billed for, they sent it to the back office and confirmed that it was correct.

I really don't care about the $92, so much as this seems like borderline fraud, and this doctor already pissed me off by telling me a bunch of incorrect bullshit and has wasted a bunch of my time.

Am I being too autistic here?

Is this how you would normally code what amounts to DM?
 

melroy

wonderin how many people ITT have been meditating
Apr 1, 2018
19,728
You asked a doctor for medical advice, he gave it and billed you for it. What more do you want? You're unwilling to work on changing the medical system so this is what you get.
 

lescivic

OT Supporter
Oct 13, 2003
1,714
Space Coast FL
Even though this is a SRS thread I appreciate what you’re doing here.
Ah shit, my bad missed that. I think it’s pretty common to mess the codes up. I needed a second urine test on my yearly and it got coded as possible uti, which had nothing to do with it. Asked them about it and they said it was so insurance would cover it.
 
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fatmoocow

fatmoocow

bored
OT Supporter
Aug 27, 2002
28,785
the intarweb
Ah shit, my bad missed that. I think it’s pretty common to mess the codes up. I needed a second urine test on my yearly and it got coded as possible uti, which had nothing to do with it. Asked them about it and they said it was so insurance would cover it.
There’s a certain amount of bullshit needed to get things done.

This seemed a bit much for a really dumb email.
 

whatever

OT Supporter
Feb 18, 2004
213,635
its perfectly reasonable for them to bill for the time to respond to DM's like that btw.
 

EE CUMMINGS

aka RobHuang
Dec 31, 2001
57,482
LA, CA
these past few months have been the first time in my life i have actually used a lot of health insurance (non preventative stuff).

i’m surprised/not surprised at the shit they bill. every time i go they have to take my weight/oxygen. those activities get billed every time. they bill $30 to put a o2 sensor on my finger for like 10 seconds :rofl:
 

whatever

OT Supporter
Feb 18, 2004
213,635
you reached out to him. he responded. async message.

  • 99421: Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5–10 minutes
 
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whatever

OT Supporter
Feb 18, 2004
213,635
03.17.2020%20Summary%20of%20Medicare%20Telemedicine%20Services%20Chart.PNG
 
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whatever

OT Supporter
Feb 18, 2004
213,635
is this new? wouldn't be surprised to see docs starting to charge for renewing refills

covid changed the rules a lot with this set. my wifes fulltime job has turned into covid policy changes and fraud detection. ex: no you can't bill a nose job as telemed :rofl:
 

dorkultra

OT's resident crohns dude
OT Supporter
Oct 14, 2005
33,341
nilbog, trollhio
covid changed the rules a lot with this set. my wifes fulltime job has turned into covid policy changes and fraud detection. ex: no you can't bill a nose job as telemed :rofl:
my existing script was denied from being refilled and then sent off for review, making me miss a dose. they then allowed it, but changed the refills from 6 weeks to 8 weeks.
i'm in the process of appealing it, because i can't accept that change unless i want to go back into a bad flareup
 
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fatmoocow

fatmoocow

bored
OT Supporter
Aug 27, 2002
28,785
the intarweb
you reached out to him. he responded. async message.

  • 99421: Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5–10 minutes

So he billed it as 99442 - Telephone evaluation and management service provided by a physician to an established patient - 15 minutes

MDM of "moderate" to literally phone in a prescription for an azole.

Never called me. He makes an extra $50 or so by billing this way.

I'm going to let it slide but the retards never resubmitted to my insurance after I called them last time, so now I've got to wait on this one to circle back to insurance and follow up once again in a month.
 

whatever

OT Supporter
Feb 18, 2004
213,635
So he billed it as 99442 - Telephone evaluation and management service provided by a physician to an established patient - 15 minutes

MDM of "moderate" to literally phone in a prescription for an azole.

Never called me. He makes an extra $50 or so by billing this way.

I'm going to let it slide but the retards never resubmitted to my insurance after I called them last time, so now I've got to wait on this one to circle back to insurance and follow up once again in a month.
this the most common way providers over bill. they upcode to more extensive time than decided on. there is no way he spend 11-20 minutes on that.


CPT CodeTimeModifiersPlace of Service
G20125-10 minN/A11
994415-10 minN/A11
9944211-20 minN/A11
9944321-30 minN/A11
Important: Effective April 30, CMS increased the allowable of 99441 to 99212, 99442 to 99213 and 99443 to 99214. The increase will be automatically made to March 1 dates of service. These codes are reported for medical discussion with the physician and should not be used for administrative or other non-medical discussion with the patient. Learn more.



CMS received numerous comments and responded favorably in the new interim final rule by increasing the reimbursement for telephone calls to the level of reimbursement for 99212-99214. What this means is 99441, a 5-10 minute call, will be reimbursed at the same rate as 99212-99442, whereas a 11-20 minute call will be reimbursed at the same rate as 99213 and 99443, and a call greater than 20 minutes will be reimbursed at the same rate as 99214.



so this fucker is getting a 21-30min reimbursement rate for what amounts to a 5-10 minute code :bowrofl: you can submit a complaint to your insurance and get it reviewed. this is the exact stuff my wife works on. :rofl:
 
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fatmoocow

fatmoocow

bored
OT Supporter
Aug 27, 2002
28,785
the intarweb
this the most common way providers over bill. they upcode to more extensive time than decided on. there is no way he spend 11-20 minutes on that.


CPT CodeTimeModifiersPlace of Service
G20125-10 minN/A11
994415-10 minN/A11
9944211-20 minN/A11
9944321-30 minN/A11
Important: Effective April 30, CMS increased the allowable of 99441 to 99212, 99442 to 99213 and 99443 to 99214. The increase will be automatically made to March 1 dates of service. These codes are reported for medical discussion with the physician and should not be used for administrative or other non-medical discussion with the patient. Learn more.



CMS received numerous comments and responded favorably in the new interim final rule by increasing the reimbursement for telephone calls to the level of reimbursement for 99212-99214. What this means is 99441, a 5-10 minute call, will be reimbursed at the same rate as 99212-99442, whereas a 11-20 minute call will be reimbursed at the same rate as 99213 and 99443, and a call greater than 20 minutes will be reimbursed at the same rate as 99214.



so this fucker is getting a 21-30min reimbursement rate for what amounts to a 5-10 minute code :bowrofl: you can submit a complaint to your insurance and get it reviewed. this is the exact stuff my wife works on. :rofl:

Yes exactly but there wasn't a even a phone call. It was just a two sentence DM that took him a week to reply to after I called their office multiple times to get a reply. Maybe 15 minutes if he filled out some paperwork and reviewed my files....but he literally told me that this shit wouldn't work because I was taking antibiotics....that I haven't taken in a year, so he obviously didn't look at my shit. Just fucking busch league.

If my insurance pays it I won't go after it, but if they waste any more of my time I will get in their ass.
 

whatever

OT Supporter
Feb 18, 2004
213,635
Yes exactly but there wasn't a even a phone call. It was just a two sentence DM that took him a week to reply to after I called their office multiple times to get a reply. Maybe 15 minutes if he filled out some paperwork and reviewed my files....but he literally told me that this shit wouldn't work because I was taking antibiotics....that I haven't taken in a year, so he obviously didn't look at my shit. Just fucking busch league.

If my insurance pays it I won't go after it, but if they waste any more of my time I will get in their ass.

these codes are able to be used for 2 way portal communication now. you initiated the communication path of the portal so he is able to respond via the same path and bill for it.
 

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