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Honored Contributor
Posts: 18,504
Registered: ‎05-23-2010

Re: Question for certified medical coder

[ Edited ]

@drizzellla wrote:

I hope you get it resolved.

 

I am currently fighting a bill for services that occurred almost a year ago. I got an EOB from my Insurance Company stated I owed nothing, But the Hospital is now billing me for an additional Surgeon. The Insurance Company already paid a surgeon and a plastic surgeon for a mastectomy. 

 

The hospital billed me previously for a lymphodema consult - that was to be free (coupon) from my Doctor. My husband said it was easier to just pay because I was getting no where with my Doctor or the hospital. So I paid for that. Now all the sudden I am getting a bill from another surgeon. I only talked and met two surgeons. I know nothng about a 3rd. 

 

I sent a note and copies of the EOB to the hospital billing department and called my Insurance Company. The Insurance Company assured me I did not owe the hospital anything additonal. But the hospital keeps billing me. Guess they just throw out the EOB and notes.


 

 

Many types of surgery pretty much require an assistant surgeon. He (or she) is in the OR assisting your primary surgeon during surgery. S/He fills a definite purpose and the surgeon needs/wants him there. You would not have necessarily ever seen the asst surgeon. I had a total hysterectomy and never saw mine, although I knew ahead of time there would be one. But yes, they bill for their services. Not every surgery requires one and not every surgeon wants one in every surgery. I'm not positive, but I believe the surgeon has to justify the reason he asked for an assistant; at least, that used to be the case.

Life without Mexican food is no life at all
Valued Contributor
Posts: 645
Registered: ‎03-10-2010

Re: Question for certified medical coder

The .25 modifier on the evaluation code indicates that it is a separate evaluation from the procedure. The .25 modifier allows the evaluation to be billed and paid on the same date a procedure is performed as it indicates there was "more than" the surgeon walking in and doing the procedure. He evaluated you and explained things, and while he evaluated you he could have seen something (or not) that would change his opinions.

 

You seem bent on complaining and looking for "fraud" where I doubt seriously there is any. 

 

Modifiers attached to many CPT codes indicate different things and allow for payments for procedures perfomed the same day as an evaluation.  

 

There is no "law" or "regulation" stating that the evaluation code can never be billed with a procedure.

 

I ran a practice for many years, so I do know why modifiers are used. .

“The price of light is less than the cost of darkness.”
– Arthur C. Nielsen
Trusted Contributor
Posts: 1,665
Registered: ‎03-14-2010

Re: Question for certified medical coder

[ Edited ]

@CatLoverDogsToo, if this is directed to me, I'm not looking for fraud, I'm looking for an explanation, which I got from @chrystaltree & @Carmie. Since it's a valid bill, I have no problem paying my co-pay, once specific  insurance issues have been resolved.

Trusted Contributor
Posts: 1,665
Registered: ‎03-14-2010

Re: Question for certified medical coder

@drizzellla, I hope you get your situation resolved as well.

Esteemed Contributor
Posts: 7,996
Registered: ‎03-14-2010

Re: Question for certified medical coder


@Moonchilde wrote:

@drizzellla wrote:

I hope you get it resolved.

 

I am currently fighting a bill for services that occurred almost a year ago. I got an EOB from my Insurance Company stated I owed nothing, But the Hospital is now billing me for an additional Surgeon. The Insurance Company already paid a surgeon and a plastic surgeon for a mastectomy. 

 

The hospital billed me previously for a lymphodema consult - that was to be free (coupon) from my Doctor. My husband said it was easier to just pay because I was getting no where with my Doctor or the hospital. So I paid for that. Now all the sudden I am getting a bill from another surgeon. I only talked and met two surgeons. I know nothng about a 3rd. 

 

I sent a note and copies of the EOB to the hospital billing department and called my Insurance Company. The Insurance Company assured me I did not owe the hospital anything additonal. But the hospital keeps billing me. Guess they just throw out the EOB and notes.


 

 

Many types of surgery pretty much require an assistant surgeon. He (or she) is in the OR assisting your primary surgeon during surgery. S/He fills a definite purpose and the surgeon needs/wants him there. You would not have necessarily ever seen the asst surgeon. I had a total hysterectomy and never saw mine, although I knew ahead of time there would be one. But yes, they bill for their services. Not every surgery requires one and not every surgeon wants one in every surgery. I'm not positive, but I believe the surgeon has to justify the reason he asked for an assistant; at least, that used to be the case.


Thanks for your input. My cancer was .2 cm and was a completely contained dot.   It had not spread. That is why I think Cigna paid for 2 surgeons. Since it was a routine mastectomy, there was no need for an assistant. In fact my surgeon never mentioned anyone but herself and the plastic surgeon doing the surgery. Or the need for any additional people working on me. And there were a few people that were paid by my insurance company I had no idea who they were. I assumed anesthesiologist and their assistants. In fact I am going to go back to all my EOBs (I have a 2 page spreadsheet of all the charges) and count all the people who particpated and were paid, the day of my surgery.

 

Clearly they have ignored the copies of the EOBs and notes I have sent. I think they are just going to continue to bill me and then send me to collections.

Esteemed Contributor
Posts: 7,996
Registered: ‎03-14-2010

Re: Question for certified medical coder

I


@Moonchilde wrote:

@drizzellla wrote:

I hope you get it resolved.

 

I am currently fighting a bill for services that occurred almost a year ago. I got an EOB from my Insurance Company stated I owed nothing, But the Hospital is now billing me for an additional Surgeon. The Insurance Company already paid a surgeon and a plastic surgeon for a mastectomy. 

 

The hospital billed me previously for a lymphodema consult - that was to be free (coupon) from my Doctor. My husband said it was easier to just pay because I was getting no where with my Doctor or the hospital. So I paid for that. Now all the sudden I am getting a bill from another surgeon. I only talked and met two surgeons. I know nothng about a 3rd. 

 

I sent a note and copies of the EOB to the hospital billing department and called my Insurance Company. The Insurance Company assured me I did not owe the hospital anything additonal. But the hospital keeps billing me. Guess they just throw out the EOB and notes.


 

 

Many types of surgery pretty much require an assistant surgeon. He (or she) is in the OR assisting your primary surgeon during surgery. S/He fills a definite purpose and the surgeon needs/wants him there. You would not have necessarily ever seen the asst surgeon. I had a total hysterectomy and never saw mine, although I knew ahead of time there would be one. But yes, they bill for their services. Not every surgery requires one and not every surgeon wants one in every surgery. I'm not positive, but I believe the surgeon has to justify the reason he asked for an assistant; at least, that used to be the case.


Well, I looked up my charges for the surgery the insurance paid

Doctor #1 - lab   Insurance also paid the Lab

Doctor #2 - diagnostic

Doctor #3 - lab

Doctor #4 - diagnostic

Doctor #5 - radiology    Insurance also paid Radiology Group

Doctor #6 - anestesia   Insurance also paid Anesthesia Group

 

plus my Surgeon and Plastic Surgeon

and I just started getting billed for another Doctor for surgery from June 2016?!?!