Guest guest Posted February 8, 2010 Report Share Posted February 8, 2010 Group, Over the past few months more and more of my patients have been forced to pay for their own labs due to my coding of the lab request. The vast majority of these are Medicare and involve follow up for high cholesterol coded with the 272.0 code. From what I understand the patient goes to the lab, is forced to sign an ABN (just in case), Medicare rejects the lab (reasons unknown to me as I am not involved in the process), and the patient is sent the bill. If the patient calls the lab to ask why they are getting a bill, they are told “your doctor gave us a code which was rejected by Medicare, so you need to call him and work it out.” Note: I never get a call from the lab saying “hey, this code you continually use does not work anymore” and when I call the lab(s), they say they cannot spend the time looking up why different codes were rejected or what will actually work. So essentially it appears to be a crap shoot to see if something gets paid, and if it doesn’t it is somehow my fault (at least to the patient). Has anyone else faced this? Can someone please point me in a direction as to where I might be able to do something simple like plug in a lab and an ICD code and see if the insurance will pay before I send my patients to get hundreds of dollars worth of labs they will then be responsible for? P.S. I am trying to refrain from going onto the soap box of how stupid and opaque this whole system is and how continually blaming everything on the primary care doc is not the way to ultimately keep costs down and encourage others to join us in choosing primary care. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 8, 2010 Report Share Posted February 8, 2010 I order my labs through the labs computer now, and with LabCorp, at least, it automatically checks to see if ABN needed and will suggest ICD-9 codes that do not need an ABN. I think Quest has a “public” web site that does the same. Otherwise, I know there are sites that have this info, possibly the local Medicare site. I think there is a site called www.mlrp.com or .org and I might be confusing the order of the letters, it could be mrlp (Medicare Local Review Policy are the words that go with the letters.) Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Dr. Brady Sent: Monday, February 08, 2010 2:04 PM To: Subject: Coding question Group, Over the past few months more and more of my patients have been forced to pay for their own labs due to my coding of the lab request. The vast majority of these are Medicare and involve follow up for high cholesterol coded with the 272.0 code. From what I understand the patient goes to the lab, is forced to sign an ABN (just in case), Medicare rejects the lab (reasons unknown to me as I am not involved in the process), and the patient is sent the bill. If the patient calls the lab to ask why they are getting a bill, they are told “your doctor gave us a code which was rejected by Medicare, so you need to call him and work it out.” Note: I never get a call from the lab saying “hey, this code you continually use does not work anymore” and when I call the lab(s), they say they cannot spend the time looking up why different codes were rejected or what will actually work. So essentially it appears to be a crap shoot to see if something gets paid, and if it doesn’t it is somehow my fault (at least to the patient). Has anyone else faced this? Can someone please point me in a direction as to where I might be able to do something simple like plug in a lab and an ICD code and see if the insurance will pay before I send my patients to get hundreds of dollars worth of labs they will then be responsible for? P.S. I am trying to refrain from going onto the soap box of how stupid and opaque this whole system is and how continually blaming everything on the primary care doc is not the way to ultimately keep costs down and encourage others to join us in choosing primary care. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 8, 2010 Report Share Posted February 8, 2010 I don't know much butI use 272.4 all the time and nothing happensYour lab does not sound very nice If they can't take the time then they apparently do not care if they get paid because patients are so much less likely to pay than a third party payor.. Sendd them elsewhere..They won;t mind when you tell them why. As an aside today i called the hospital to find out what a cas h paying patient would pay for a colonoscopy All they could tell me was the average cost over 445 patients and when I was smart enough to inquire about the doctors fees they said oh that is different.Though I had said, please tell me the entire costs including the surgeon and anestheisa room fee etc. They w en t into the oh but it depends on the patient YES I uh know that some people had a polyp some have two some have none , what are the charges for each? and they were absolutely unable to answer and rather miffed with me that I wo uld have a cash paying paitent. I was told that after a procedure it goes to coding Right I know that! so each procedure has a code and a charge would be listed WHat are they? What is this the KGB? Do we have average charges for the cheerios at the grocery store?? I was referred to some one else who has not calle d me back yet. Group, Over the past few months more and more of my patients have been forced to pay for their own labs due to my coding of the lab request. The vast majority of these are Medicare and involve follow up for high cholesterol coded with the 272.0 code. From what I understand the patient goes to the lab, is forced to sign an ABN (just in case), Medicare rejects the lab (reasons unknown to me as I am not involved in the process), and the patient is sent the bill. If the patient calls the lab to ask why they are getting a bill, they are told “your doctor gave us a code which was rejected by Medicare, so you need to call him and work it out.” Note: I never get a call from the lab saying “hey, this code you continually use does not work anymore” and when I call the lab(s), they say they cannot spend the time looking up why different codes were rejected or what will actually work. So essentially it appears to be a crap shoot to see if something gets paid, and if it doesn’t it is somehow my fault (at least to the patient). Has anyone else faced this? Can someone please point me in a direction as to where I might be able to do something simple like plug in a lab and an ICD code and see if the insurance will pay before I send my patients to get hundreds of dollars worth of labs they will then be responsible for? P.S. I am trying to refrain from going onto the soap box of how stupid and opaque this whole system is and how continually blaming everything on the primary care doc is not the way to ultimately keep costs down and encourage others to join us in choosing primary care. -- PATIENTS,please remember email may not be entirely secure and that Email is part of the medical record and is placed into the chart ( be careful what you say!)Email is best used for appointment making and brief questions Email replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 8, 2010 Report Share Posted February 8, 2010 I can bet that you are not the problem; the lab has some billing issue. from The Barrio From: [mailto: ] On Behalf Of Jean Antonucci Sent: Monday, February 08, 2010 3:01 PM To: Subject: Re: Coding question I don't know much but I use 272.4 all the time and nothing happens Your lab does not sound very nice If they can't take the time then they apparently do not care if they get paid because patients are so much less likely to pay than a third party payor.. Sendd them elsewhere..They won;t mind when you tell them why. As an aside today i called the hospital to find out what a cas h paying patient would pay for a colonoscopy All they could tell me was the average cost over 445 patients and when I was smart enough to inquire about the doctors fees they said oh that is different.Though I had said, please tell me the entire costs including the surgeon and anestheisa room fee etc. They w en t into the oh but it depends on the patient YES I uh know that some people had a polyp some have two some have none , what are the charges for each? and they were absolutely unable to answer and rather miffed with me that I wo uld have a cash paying paitent. I was told that after a procedure it goes to coding Right I know that! so each procedure has a code and a charge would be listed WHat are they? What is this the KGB? Do we have average charges for the cheerios at the grocery store?? I was referred to some one else who has not calle d me back yet. On Mon, Feb 8, 2010 at 2:03 PM, Dr. Brady wrote: Group, Over the past few months more and more of my patients have been forced to pay for their own labs due to my coding of the lab request. The vast majority of these are Medicare and involve follow up for high cholesterol coded with the 272.0 code. From what I understand the patient goes to the lab, is forced to sign an ABN (just in case), Medicare rejects the lab (reasons unknown to me as I am not involved in the process), and the patient is sent the bill. If the patient calls the lab to ask why they are getting a bill, they are told “your doctor gave us a code which was rejected by Medicare, so you need to call him and work it out.” Note: I never get a call from the lab saying “hey, this code you continually use does not work anymore” and when I call the lab(s), they say they cannot spend the time looking up why different codes were rejected or what will actually work. So essentially it appears to be a crap shoot to see if something gets paid, and if it doesn’t it is somehow my fault (at least to the patient). Has anyone else faced this? Can someone please point me in a direction as to where I might be able to do something simple like plug in a lab and an ICD code and see if the insurance will pay before I send my patients to get hundreds of dollars worth of labs they will then be responsible for? P.S. I am trying to refrain from going onto the soap box of how stupid and opaque this whole system is and how continually blaming everything on the primary care doc is not the way to ultimately keep costs down and encourage others to join us in choosing primary care. -- PATIENTS,please remember email may not be entirely secure and that Email is part of the medical record and is placed into the chart ( be careful what you say!) Email is best used for appointment making and brief questions Email replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 8, 2010 Report Share Posted February 8, 2010 , What test are you trying to order that you are using the 272 code to justify? Train you patients to refuse to sign the ABN unless you know ahead of time that it is not a covered test and the patient just wants it. Then you will get these problems before the patient is mad they are stuck with a bill and maybe the lab will call you for a “better” code? BTW, the lrmp site is down. I saw it referred to in an article and it’s no longer functional. I have been trying to find a site. Must be on CMS, the have all these National policies but local policies come from your Medicare carrier. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Batlle Sent: Monday, February 08, 2010 4:14 PM To: Subject: RE: Coding question I can bet that you are not the problem; the lab has some billing issue. from The Barrio From: [mailto: ] On Behalf Of Sent: Monday, February 08, 2010 3:01 PM To: Subject: Re: Coding question I don't know much but I use 272.4 all the time and nothing happens Your lab does not sound very nice If they can't take the time then they apparently do not care if they get paid because patients are so much less likely to pay than a third party payor.. Sendd them elsewhere..They won;t mind when you tell them why. As an aside today i called the hospital to find out what a cas h paying patient would pay for a colonoscopy All they could tell me was the average cost over 445 patients and when I was smart enough to inquire about the doctors fees they said oh that is different.Though I had said, please tell me the entire costs including the surgeon and anestheisa room fee etc. They w en t into the oh but it depends on the patient YES I uh know that some people had a polyp some have two some have none , what are the charges for each? and they were absolutely unable to answer and rather miffed with me that I wo uld have a cash paying paitent. I was told that after a procedure it goes to coding Right I know that! so each procedure has a code and a charge would be listed WHat are they? What is this the KGB? Do we have average charges for the cheerios at the grocery store?? I was referred to some one else who has not calle d me back yet. On Mon, Feb 8, 2010 at 2:03 PM, Dr. Brady wrote: Group, Over the past few months more and more of my patients have been forced to pay for their own labs due to my coding of the lab request. The vast majority of these are Medicare and involve follow up for high cholesterol coded with the 272.0 code. From what I understand the patient goes to the lab, is forced to sign an ABN (just in case), Medicare rejects the lab (reasons unknown to me as I am not involved in the process), and the patient is sent the bill. If the patient calls the lab to ask why they are getting a bill, they are told “your doctor gave us a code which was rejected by Medicare, so you need to call him and work it out.” Note: I never get a call from the lab saying “hey, this code you continually use does not work anymore” and when I call the lab(s), they say they cannot spend the time looking up why different codes were rejected or what will actually work. So essentially it appears to be a crap shoot to see if something gets paid, and if it doesn’t it is somehow my fault (at least to the patient). Has anyone else faced this? Can someone please point me in a direction as to where I might be able to do something simple like plug in a lab and an ICD code and see if the insurance will pay before I send my patients to get hundreds of dollars worth of labs they will then be responsible for? P.S. I am trying to refrain from going onto the soap box of how stupid and opaque this whole system is and how continually blaming everything on the primary care doc is not the way to ultimately keep costs down and encourage others to join us in choosing primary care. -- PATIENTS,please remember email may not be entirely secure and that Email is part of the medical record and is placed into the chart ( be careful what you say!) Email is best used for appointment making and brief questions Email replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 8, 2010 Report Share Posted February 8, 2010 http://www.sonoraquest.com/documents/mdg-lipid_profile_cholesterol_testing.pdf Looks like your code should be good according to this document that lists all the codes that should be paid for a non-screening lipid panel. Carla To: Sent: Mon, February 8, 2010 12:03:52 PMSubject: Coding question Group, Over the past few months more and more of my patients have been forced to pay for their own labs due to my coding of the lab request. The vast majority of these are Medicare and involve follow up for high cholesterol coded with the 272.0 code. From what I understand the patient goes to the lab, is forced to sign an ABN (just in case), Medicare rejects the lab (reasons unknown to me as I am not involved in the process), and the patient is sent the bill. If the patient calls the lab to ask why they are getting a bill, they are told “your doctor gave us a code which was rejected by Medicare, so you need to call him and work it out.†Note: I never get a call from the lab saying “hey, this code you continually use does not work anymore†and when I call the lab(s), they say they cannot spend the time looking up why different codes were rejected or what will actually work. So essentially it appears to be a crap shoot to see if something gets paid, and if it doesn’t it is somehow my fault (at least to the patient). Has anyone else faced this? Can someone please point me in a direction as to where I might be able to do something simple like plug in a lab and an ICD code and see if the insurance will pay before I send my patients to get hundreds of dollars worth of labs they will then be responsible for? P.S. I am trying to refrain from going onto the soap box of how stupid and opaque this whole system is and how continually blaming everything on the primary care doc is not the way to ultimately keep costs down and encourage others to join us in choosing primary care. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2010 Report Share Posted February 9, 2010 Thanks Carla, it looks like the code should be accepted. I may need to just go back to the lab and try and figure all this out. From: [mailto: ] On Behalf Of Carla Gibson Sent: Monday, February 08, 2010 4:41 PM To: Subject: Re: Coding question http://www.sonoraquest.com/documents/mdg-lipid_profile_cholesterol_testing.pdf Looks like your code should be good according to this document that lists all the codes that should be paid for a non-screening lipid panel. Carla From: Dr. Brady To: Sent: Mon, February 8, 2010 12:03:52 PM Subject: Coding question Group, Over the past few months more and more of my patients have been forced to pay for their own labs due to my coding of the lab request. The vast majority of these are Medicare and involve follow up for high cholesterol coded with the 272.0 code. From what I understand the patient goes to the lab, is forced to sign an ABN (just in case), Medicare rejects the lab (reasons unknown to me as I am not involved in the process), and the patient is sent the bill. If the patient calls the lab to ask why they are getting a bill, they are told “your doctor gave us a code which was rejected by Medicare, so you need to call him and work it out.†Note: I never get a call from the lab saying “hey, this code you continually use does not work anymore†and when I call the lab(s), they say they cannot spend the time looking up why different codes were rejected or what will actually work. So essentially it appears to be a crap shoot to see if something gets paid, and if it doesn’t it is somehow my fault (at least to the patient). Has anyone else faced this? Can someone please point me in a direction as to where I might be able to do something simple like plug in a lab and an ICD code and see if the insurance will pay before I send my patients to get hundreds of dollars worth of labs they will then be responsible for? P.S. I am trying to refrain from going onto the soap box of how stupid and opaque this whole system is and how continually blaming everything on the primary care doc is not the way to ultimately keep costs down and encourage others to join us in choosing primary care. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2010 Report Share Posted February 9, 2010 Kathy, I am using the 272.0 to justify a lipid panel. I will talk to my patients about not signing the ABN. I wonder if they refuse to sign if they will be refused service. Hmmm, might be good to find out. From: [mailto: ] On Behalf Of Kathy Saradarian Sent: Monday, February 08, 2010 4:28 PM To: Subject: RE: Coding question , What test are you trying to order that you are using the 272 code to justify? Train you patients to refuse to sign the ABN unless you know ahead of time that it is not a covered test and the patient just wants it. Then you will get these problems before the patient is mad they are stuck with a bill and maybe the lab will call you for a “better” code? BTW, the lrmp site is down. I saw it referred to in an article and it’s no longer functional. I have been trying to find a site. Must be on CMS, the have all these National policies but local policies come from your Medicare carrier. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Batlle Sent: Monday, February 08, 2010 4:14 PM To: Subject: RE: Coding question I can bet that you are not the problem; the lab has some billing issue. from The Barrio From: [mailto: ] On Behalf Of Sent: Monday, February 08, 2010 3:01 PM To: Subject: Re: Coding question I don't know much but I use 272.4 all the time and nothing happens Your lab does not sound very nice If they can't take the time then they apparently do not care if they get paid because patients are so much less likely to pay than a third party payor.. Sendd them elsewhere..They won;t mind when you tell them why. As an aside today i called the hospital to find out what a cas h paying patient would pay for a colonoscopy All they could tell me was the average cost over 445 patients and when I was smart enough to inquire about the doctors fees they said oh that is different.Though I had said, please tell me the entire costs including the surgeon and anestheisa room fee etc. They w en t into the oh but it depends on the patient YES I uh know that some people had a polyp some have two some have none , what are the charges for each? and they were absolutely unable to answer and rather miffed with me that I wo uld have a cash paying paitent. I was told that after a procedure it goes to coding Right I know that! so each procedure has a code and a charge would be listed WHat are they? What is this the KGB? Do we have average charges for the cheerios at the grocery store?? I was referred to some one else who has not calle d me back yet. On Mon, Feb 8, 2010 at 2:03 PM, Dr. Brady wrote: Group, Over the past few months more and more of my patients have been forced to pay for their own labs due to my coding of the lab request. The vast majority of these are Medicare and involve follow up for high cholesterol coded with the 272.0 code. From what I understand the patient goes to the lab, is forced to sign an ABN (just in case), Medicare rejects the lab (reasons unknown to me as I am not involved in the process), and the patient is sent the bill. If the patient calls the lab to ask why they are getting a bill, they are told “your doctor gave us a code which was rejected by Medicare, so you need to call him and work it out.” Note: I never get a call from the lab saying “hey, this code you continually use does not work anymore” and when I call the lab(s), they say they cannot spend the time looking up why different codes were rejected or what will actually work. So essentially it appears to be a crap shoot to see if something gets paid, and if it doesn’t it is somehow my fault (at least to the patient). Has anyone else faced this? Can someone please point me in a direction as to where I might be able to do something simple like plug in a lab and an ICD code and see if the insurance will pay before I send my patients to get hundreds of dollars worth of labs they will then be responsible for? P.S. I am trying to refrain from going onto the soap box of how stupid and opaque this whole system is and how continually blaming everything on the primary care doc is not the way to ultimately keep costs down and encourage others to join us in choosing primary care. -- PATIENTS,please remember email may not be entirely secure and that Email is part of the medical record and is placed into the chart ( be careful what you say!) Email is best used for appointment making and brief questions Email replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2010 Report Share Posted February 9, 2010 , The problem is that I still get blamed for it. That is what I have to sort out. From: [mailto: ] On Behalf Of Batlle Sent: Monday, February 08, 2010 4:14 PM To: Subject: RE: Coding question I can bet that you are not the problem; the lab has some billing issue. from The Barrio From: [mailto: ] On Behalf Of Jean Antonucci Sent: Monday, February 08, 2010 3:01 PM To: Subject: Re: Coding question I don't know much but I use 272.4 all the time and nothing happens Your lab does not sound very nice If they can't take the time then they apparently do not care if they get paid because patients are so much less likely to pay than a third party payor.. Sendd them elsewhere..They won;t mind when you tell them why. As an aside today i called the hospital to find out what a cas h paying patient would pay for a colonoscopy All they could tell me was the average cost over 445 patients and when I was smart enough to inquire about the doctors fees they said oh that is different.Though I had said, please tell me the entire costs including the surgeon and anestheisa room fee etc. They w en t into the oh but it depends on the patient YES I uh know that some people had a polyp some have two some have none , what are the charges for each? and they were absolutely unable to answer and rather miffed with me that I wo uld have a cash paying paitent. I was told that after a procedure it goes to coding Right I know that! so each procedure has a code and a charge would be listed WHat are they? What is this the KGB? Do we have average charges for the cheerios at the grocery store?? I was referred to some one else who has not calle d me back yet. On Mon, Feb 8, 2010 at 2:03 PM, Dr. Brady wrote: Group, Over the past few months more and more of my patients have been forced to pay for their own labs due to my coding of the lab request. The vast majority of these are Medicare and involve follow up for high cholesterol coded with the 272.0 code. From what I understand the patient goes to the lab, is forced to sign an ABN (just in case), Medicare rejects the lab (reasons unknown to me as I am not involved in the process), and the patient is sent the bill. If the patient calls the lab to ask why they are getting a bill, they are told “your doctor gave us a code which was rejected by Medicare, so you need to call him and work it out.” Note: I never get a call from the lab saying “hey, this code you continually use does not work anymore” and when I call the lab(s), they say they cannot spend the time looking up why different codes were rejected or what will actually work. So essentially it appears to be a crap shoot to see if something gets paid, and if it doesn’t it is somehow my fault (at least to the patient). Has anyone else faced this? Can someone please point me in a direction as to where I might be able to do something simple like plug in a lab and an ICD code and see if the insurance will pay before I send my patients to get hundreds of dollars worth of labs they will then be responsible for? P.S. I am trying to refrain from going onto the soap box of how stupid and opaque this whole system is and how continually blaming everything on the primary care doc is not the way to ultimately keep costs down and encourage others to join us in choosing primary care. -- PATIENTS,please remember email may not be entirely secure and that Email is part of the medical record and is placed into the chart ( be careful what you say!) Email is best used for appointment making and brief questions Email replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2010 Report Share Posted February 9, 2010 ,Have you tried contacting Medicare directly and asking them why the charge was denied? It could be something as simple as the lab clerk entering the ICD9 code incorrectly. SetoSouth Pasadena, CAThanks Carla, it looks like the code should be accepted. I may need to just go back to the lab and try and figure all this out. From: [mailto: ] On Behalf Of Carla GibsonSent: Monday, February 08, 2010 4:41 PMTo: Subject: Re: Coding question http://www.sonoraquest.com/documents/mdg-lipid_profile_cholesterol_testing.pdf Looks like your code should be good according to this document that lists all the codes that should be paid for a non-screening lipid panel. Carla From: Dr. Brady <drbradythevillagedoctor (DOT) hrcoxmail.com>To: Sent: Mon, February 8, 2010 12:03:52 PMSubject: Coding question Group,Over the past few months more and more of my patients have been forced to pay for their own labs due to my coding of the lab request. The vast majority of these are Medicare and involve follow up for high cholesterol coded with the 272.0 code. From what I understand the patient goes to the lab, is forced to sign an ABN (just in case), Medicare rejects the lab (reasons unknown to me as I am not involved in the process), and the patient is sent the bill. If the patient calls the lab to ask why they are getting a bill, they are told “your doctor gave us a code which was rejected by Medicare, so you need to call him and work it out.” Note: I never get a call from the lab saying “hey, this code you continually use does not work anymore” and when I call the lab(s), they say they cannot spend the time looking up why different codes were rejected or what will actually work. So essentially it appears to be a crap shoot to see if something gets paid, and if it doesn’t it is somehow my fault (at least to the patient). Has anyone else faced this? Can someone please point me in a direction as to where I might be able to do something simple like plug in a lab and an ICD code and see if the insurance will pay before I send my patients to get hundreds of dollars worth of labs they will then be responsible for?P.S. I am trying to refrain from going onto the soap box of how stupid and opaque this whole system is and how continually blaming everything on the primary care doc is not the way to ultimately keep costs down and encourage others to join us in choosing primary care. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2010 Report Share Posted February 9, 2010 I thought about doing the order entry with the lab thing, but then I have to put in all the demographics over again. Historically, this seemed like increasing the admin burden for no reimbursement. Why should I do it if the lab is getting paid for the test? My EMR can do this automatically, but I would have to use LabCorp which is not well run in this area and my patients have to wait hours to get stuck and routinely have labs lost. Maybe I should relook at the issue. From: [mailto: ] On Behalf Of Kathy Saradarian Sent: Monday, February 08, 2010 2:50 PM To: Subject: RE: Coding question I order my labs through the labs computer now, and with LabCorp, at least, it automatically checks to see if ABN needed and will suggest ICD-9 codes that do not need an ABN. I think Quest has a “public” web site that does the same. Otherwise, I know there are sites that have this info, possibly the local Medicare site. I think there is a site called www.mlrp.com or .org and I might be confusing the order of the letters, it could be mrlp (Medicare Local Review Policy are the words that go with the letters.) Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Dr. Brady Sent: Monday, February 08, 2010 2:04 PM To: Subject: Coding question Group, Over the past few months more and more of my patients have been forced to pay for their own labs due to my coding of the lab request. The vast majority of these are Medicare and involve follow up for high cholesterol coded with the 272.0 code. From what I understand the patient goes to the lab, is forced to sign an ABN (just in case), Medicare rejects the lab (reasons unknown to me as I am not involved in the process), and the patient is sent the bill. If the patient calls the lab to ask why they are getting a bill, they are told “your doctor gave us a code which was rejected by Medicare, so you need to call him and work it out.” Note: I never get a call from the lab saying “hey, this code you continually use does not work anymore” and when I call the lab(s), they say they cannot spend the time looking up why different codes were rejected or what will actually work. So essentially it appears to be a crap shoot to see if something gets paid, and if it doesn’t it is somehow my fault (at least to the patient). Has anyone else faced this? Can someone please point me in a direction as to where I might be able to do something simple like plug in a lab and an ICD code and see if the insurance will pay before I send my patients to get hundreds of dollars worth of labs they will then be responsible for? P.S. I am trying to refrain from going onto the soap box of how stupid and opaque this whole system is and how continually blaming everything on the primary care doc is not the way to ultimately keep costs down and encourage others to join us in choosing primary care. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2010 Report Share Posted February 9, 2010 Not yet, I’m getting all this third hand from 2 angry patients who called this am wondering why I messed up. I’ll have them bring in the bill and I will call Medicare. From: [mailto: ] On Behalf Of Seto Sent: Monday, February 08, 2010 7:19 PM To: Subject: Re: Coding question , Have you tried contacting Medicare directly and asking them why the charge was denied? It could be something as simple as the lab clerk entering the ICD9 code incorrectly. Seto South Pasadena, CA Thanks Carla, it looks like the code should be accepted. I may need to just go back to the lab and try and figure all this out. From: [mailto: ] On Behalf Of Carla Gibson Sent: Monday, February 08, 2010 4:41 PM To: Subject: Re: Coding question http://www.sonoraquest.com/documents/mdg-lipid_profile_cholesterol_testing.pdf Looks like your code should be good according to this document that lists all the codes that should be paid for a non-screening lipid panel. Carla To: Sent: Mon, February 8, 2010 12:03:52 PM Subject: Coding question Group, Over the past few months more and more of my patients have been forced to pay for their own labs due to my coding of the lab request. The vast majority of these are Medicare and involve follow up for high cholesterol coded with the 272.0 code. From what I understand the patient goes to the lab, is forced to sign an ABN (just in case), Medicare rejects the lab (reasons unknown to me as I am not involved in the process), and the patient is sent the bill. If the patient calls the lab to ask why they are getting a bill, they are told “your doctor gave us a code which was rejected by Medicare, so you need to call him and work it out.” Note: I never get a call from the lab saying “hey, this code you continually use does not work anymore” and when I call the lab(s), they say they cannot spend the time looking up why different codes were rejected or what will actually work. So essentially it appears to be a crap shoot to see if something gets paid, and if it doesn’t it is somehow my fault (at least to the patient). Has anyone else faced this? Can someone please point me in a direction as to where I might be able to do something simple like plug in a lab and an ICD code and see if the insurance will pay before I send my patients to get hundreds of dollars worth of labs they will then be responsible for? P.S. I am trying to refrain from going onto the soap box of how stupid and opaque this whole system is and how continually blaming everything on the primary care doc is not the way to ultimately keep costs down and encourage others to join us in choosing primary care. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2010 Report Share Posted February 9, 2010 , 272.0 should definitely justify a lipid panel. I wonder if the lab even bills Medicare after they have gotten an ABN. If the patient refuses to sign, the lab will refuse to draw that test. But then , at least, you will know before the fact there is a problem, instead of after the fact. I have an interface with LabCorp with my EMR. I hand input Quest. Now it’s not that many, but I only have to add the patient to Quest once. And their site is pretty easy and does live eligibility checking. I figure it reduces transcription errors and I get the labs I order if I put them in the computer. If there’s a mess up, it’s usually on me. But I never mess up ;-) Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Dr. Brady Sent: Monday, February 08, 2010 7:15 PM To: Subject: RE: Coding question Kathy, I am using the 272.0 to justify a lipid panel. I will talk to my patients about not signing the ABN. I wonder if they refuse to sign if they will be refused service. Hmmm, might be good to find out. From: [mailto: ] On Behalf Of Kathy Saradarian Sent: Monday, February 08, 2010 4:28 PM To: Subject: RE: Coding question , What test are you trying to order that you are using the 272 code to justify? Train you patients to refuse to sign the ABN unless you know ahead of time that it is not a covered test and the patient just wants it. Then you will get these problems before the patient is mad they are stuck with a bill and maybe the lab will call you for a “better” code? BTW, the lrmp site is down. I saw it referred to in an article and it’s no longer functional. I have been trying to find a site. Must be on CMS, the have all these National policies but local policies come from your Medicare carrier. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Batlle Sent: Monday, February 08, 2010 4:14 PM To: Subject: RE: Coding question I can bet that you are not the problem; the lab has some billing issue. from The Barrio From: [mailto: ] On Behalf Of Sent: Monday, February 08, 2010 3:01 PM To: Subject: Re: Coding question I don't know much but I use 272.4 all the time and nothing happens Your lab does not sound very nice If they can't take the time then they apparently do not care if they get paid because patients are so much less likely to pay than a third party payor.. Sendd them elsewhere..They won;t mind when you tell them why. As an aside today i called the hospital to find out what a cas h paying patient would pay for a colonoscopy All they could tell me was the average cost over 445 patients and when I was smart enough to inquire about the doctors fees they said oh that is different.Though I had said, please tell me the entire costs including the surgeon and anestheisa room fee etc. They w en t into the oh but it depends on the patient YES I uh know that some people had a polyp some have two some have none , what are the charges for each? and they were absolutely unable to answer and rather miffed with me that I wo uld have a cash paying paitent. I was told that after a procedure it goes to coding Right I know that! so each procedure has a code and a charge would be listed WHat are they? What is this the KGB? Do we have average charges for the cheerios at the grocery store?? I was referred to some one else who has not calle d me back yet. On Mon, Feb 8, 2010 at 2:03 PM, Dr. Brady wrote: Group, Over the past few months more and more of my patients have been forced to pay for their own labs due to my coding of the lab request. The vast majority of these are Medicare and involve follow up for high cholesterol coded with the 272.0 code. From what I understand the patient goes to the lab, is forced to sign an ABN (just in case), Medicare rejects the lab (reasons unknown to me as I am not involved in the process), and the patient is sent the bill. If the patient calls the lab to ask why they are getting a bill, they are told “your doctor gave us a code which was rejected by Medicare, so you need to call him and work it out.” Note: I never get a call from the lab saying “hey, this code you continually use does not work anymore” and when I call the lab(s), they say they cannot spend the time looking up why different codes were rejected or what will actually work. So essentially it appears to be a crap shoot to see if something gets paid, and if it doesn’t it is somehow my fault (at least to the patient). Has anyone else faced this? Can someone please point me in a direction as to where I might be able to do something simple like plug in a lab and an ICD code and see if the insurance will pay before I send my patients to get hundreds of dollars worth of labs they will then be responsible for? P.S. I am trying to refrain from going onto the soap box of how stupid and opaque this whole system is and how continually blaming everything on the primary care doc is not the way to ultimately keep costs down and encourage others to join us in choosing primary care. -- PATIENTS,please remember email may not be entirely secure and that Email is part of the medical record and is placed into the chart ( be careful what you say!) Email is best used for appointment making and brief questions Email replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2010 Report Share Posted February 9, 2010 I never submit ABNs with the requisitions for blood drawn in my office. The labs usually call me up if a code is not sufficiently truncated. The way I see it is that the lab has much more lattitude in billing the patient with a signed ABN on hand. I suspect your code was either keyed in wrong or omitted altogether, resulting in denial by Medicare. I also read somewhere that there is a limitation issue when it comes to repeat ambulatory testing with Medicare. Group, Over the past few months more and more of my patients have been forced to pay for their own labs due to my coding of the lab request. The vast majority of these are Medicare and involve follow up for high cholesterol coded with the 272.0 code. From what I understand the patient goes to the lab, is forced to sign an ABN (just in case), Medicare rejects the lab (reasons unknown to me as I am not involved in the process), and the patient is sent the bill. If the patient calls the lab to ask why they are getting a bill, they are told “your doctor gave us a code which was rejected by Medicare, so you need to call him and work it out.†Note: I never get a call from the lab saying “hey, this code you continually use does not work anymore†and when I call the lab(s), they say they cannot spend the time looking up why different codes were rejected or what will actually work. So essentially it appears to be a crap shoot to see if something gets paid, and if it doesn’t it is somehow my fault (at least to the patient). Has anyone else faced this? Can someone please point me in a direction as to where I might be able to do something simple like plug in a lab and an ICD code and see if the insurance will pay before I send my patients to get hundreds of dollars worth of labs they will then be responsible for? P.S. I am trying to refrain from going onto the soap box of how stupid and opaque this whole system is and how continually blaming everything on the primary care doc is not the way to ultimately keep costs down and encourage others to join us in choosing primary care. -- PATIENTS,please remember email may not be entirely secure and that Email is part of the medical record and is placed into the chart ( be careful what you say!)Email is best used for appointment making and brief questionsEmail replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2010 Report Share Posted February 9, 2010 why should call Medicare??Why a re the patients angry at him?This is a lab issueLookI have a lab and they call me and say this dx isn't covered in the rare case of that being true and i say ok try X or i say well that's all I got., tell the patient if he wants it it isn;t covered. in fact my lab is hysterical they call and want me to clarify dm type 1 or 2 controlled or uncontrolled HOW DO I KNOW UNTIL I SEE THE RESULTS??they want BPH with or without obstruction and they want , get this, when I order a psa and say screenign they w ant me to tell them screening for what. WHAT DO YOU THINK, DONNA , I SAY, HEART DISEASE?? IT " S A PSA!!?? So now they call me an d say I need clarification on s labs and I just include it all Obstructed I say type 2 controlled No dysuria has prostatecancer.I mean lighten up pupcakes.It isn;t ;s problem, and if he sucks it up how exactly does that help anyone except his kids have to learn to cook dinner cuz he ain;t home to do it ?? His job is to dx and treat I would call the lab supervisor once MAybe i would tell the patietn that this was bizarre or maybe if i was in a good mood I would say it was nuts and tell the patietn to speak to the lab supervisor or take it elsewhere and be done with it A good lab figures this stuff out! it ain;t Brady's job to supervise every little niggel and squiqqle of the system Good lord this is exaclty why no one will go into primary care!!! Not yet, I’m getting all this third hand from 2 angry patients who called this am wondering why I messed up. I’ll have them bring in the bill and I will call Medicare. From: [mailto: ] On Behalf Of Seto Sent: Monday, February 08, 2010 7:19 PM To: Subject: Re: Coding question , Have you tried contacting Medicare directly and asking them why the charge was denied? It could be something as simple as the lab clerk entering the ICD9 code incorrectly. Seto South Pasadena, CA Thanks Carla, it looks like the code should be accepted. I may need to just go back to the lab and try and figure all this out. From: [mailto: ] On Behalf Of Carla Gibson Sent: Monday, February 08, 2010 4:41 PM To: Subject: Re: Coding question http://www.sonoraquest.com/documents/mdg-lipid_profile_cholesterol_testing.pdf Looks like your code should be good according to this document that lists all the codes that should be paid for a non-screening lipid panel. Carla From: Dr. Brady To: Sent: Mon, February 8, 2010 12:03:52 PM Subject: Coding question Group, Over the past few months more and more of my patients have been forced to pay for their own labs due to my coding of the lab request. The vast majority of these are Medicare and involve follow up for high cholesterol coded with the 272.0 code. From what I understand the patient goes to the lab, is forced to sign an ABN (just in case), Medicare rejects the lab (reasons unknown to me as I am not involved in the process), and the patient is sent the bill. If the patient calls the lab to ask why they are getting a bill, they are told “your doctor gave us a code which was rejected by Medicare, so you need to call him and work it out.” Note: I never get a call from the lab saying “hey, this code you continually use does not work anymore” and when I call the lab(s), they say they cannot spend the time looking up why different codes were rejected or what will actually work. So essentially it appears to be a crap shoot to see if something gets paid, and if it doesn’t it is somehow my fault (at least to the patient). Has anyone else faced this? Can someone please point me in a direction as to where I might be able to do something simple like plug in a lab and an ICD code and see if the insurance will pay before I send my patients to get hundreds of dollars worth of labs they will then be responsible for? P.S. I am trying to refrain from going onto the soap box of how stupid and opaque this whole system is and how continually blaming everything on the primary care doc is not the way to ultimately keep costs down and encourage others to join us in choosing primary care. -- PATIENTS,please remember email may not be entirely secure and that Email is part of the medical record and is placed into the chart ( be careful what you say!)Email is best used for appointment making and brief questions Email replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2010 Report Share Posted February 9, 2010 The labs I deal with also require an ABN for all medical necessity dictated lab tests. Most of these have not only diagnostic code requirements but also minimum frequency requirements that dictate if a lab will be paid for too. Per my LabCorp representative, patients are required to sign an ABN anytime they have these tests done because if they have had the same test ordered by another doctor within the frequency limits and you then order the test it will be denied. Unfortunately, what I have found in terms of the labs is that if it is denied its denied, trying to find out the exact reason for the denial is next to impossible from the lab. What I usually do is have the patient bring in their EOB so I can look at the actual denial codes. I would bet that the timing issue is the more likely reason for your problem than the diagnosis code being wrong. Beth Sullivan, DO Ridgeway Family Practice Commerce, GA 30529 From: [mailto: ] On Behalf Of Seto Sent: Monday, February 08, 2010 7:19 PM To: Subject: Re: Coding question , Have you tried contacting Medicare directly and asking them why the charge was denied? It could be something as simple as the lab clerk entering the ICD9 code incorrectly. Seto South Pasadena, CA Thanks Carla, it looks like the code should be accepted. I may need to just go back to the lab and try and figure all this out. From: [mailto: ] On Behalf Of Carla Gibson Sent: Monday, February 08, 2010 4:41 PM To: Subject: Re: Coding question http://www.sonoraquest.com/documents/mdg-lipid_profile_cholesterol_testing.pdf Looks like your code should be good according to this document that lists all the codes that should be paid for a non-screening lipid panel. Carla To: Sent: Mon, February 8, 2010 12:03:52 PM Subject: Coding question Group, Over the past few months more and more of my patients have been forced to pay for their own labs due to my coding of the lab request. The vast majority of these are Medicare and involve follow up for high cholesterol coded with the 272.0 code. From what I understand the patient goes to the lab, is forced to sign an ABN (just in case), Medicare rejects the lab (reasons unknown to me as I am not involved in the process), and the patient is sent the bill. If the patient calls the lab to ask why they are getting a bill, they are told “your doctor gave us a code which was rejected by Medicare, so you need to call him and work it out.” Note: I never get a call from the lab saying “hey, this code you continually use does not work anymore” and when I call the lab(s), they say they cannot spend the time looking up why different codes were rejected or what will actually work. So essentially it appears to be a crap shoot to see if something gets paid, and if it doesn’t it is somehow my fault (at least to the patient). Has anyone else faced this? Can someone please point me in a direction as to where I might be able to do something simple like plug in a lab and an ICD code and see if the insurance will pay before I send my patients to get hundreds of dollars worth of labs they will then be responsible for? P.S. I am trying to refrain from going onto the soap box of how stupid and opaque this whole system is and how continually blaming everything on the primary care doc is not the way to ultimately keep costs down and encourage others to join us in choosing primary care. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2010 Report Share Posted February 9, 2010 , I use 272.4 I cant say what the difference is between the two codes. Just know that it seems to work and I have not fielded significant calls / complaints about it so I keep using it. I'm sorry about the rejections and the complaints. That is so frustrating. Mike Safran Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2010 Report Share Posted February 9, 2010 It’s true that the system is stupid. But the bottom line is the patient has no control over the codes, the doctor picks the codes which makes the doctor responsible. The patient can’t change the codes. It’s always the doctor’s fault, everything is the doctor’s fault. Now once the doctor has ascertained that they did indeed code correctly and it should be covered, then the patient can fight it directly with their insurance and with the lab. But until the correct code is used, they can’t do a thing other than pay. BTW, you are very lucky your lab accepts words. But that does open you to error as you are expecting a lab tech to interpret your words into codes. It’s a risk. PS: Chocolate gone, can’t send Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Jean Antonucci Sent: Tuesday, February 09, 2010 8:11 AM To: Subject: Re: Coding question The other thing that is fascinating here is that Brady gets blamed I bet Brady gets blmed becasue he has a relationship with the patient and they CAN FIND him to blame him He has aface and a voice and is a real person they can access. The lab is a mindless bureaucracy staffed by anonymous ever changing people handing papers back to people saying " yourdoctordiditwrong " eg " go away it would take work to problem solve this " Becasue Brady is an IMP he gets MORE stuff that flows downhill to him People expect him to do better becasue he always does. I bet this does not happen in big practices- I bet I bet patients there do not get the labs done, can';t find anyone to tell and disappaer without care How perverted Brady does good Brady gets punished. egads Send chocolate Jean On Mon, Feb 8, 2010 at 7:26 PM, Dr. Brady wrote: Not yet, I’m getting all this third hand from 2 angry patients who called this am wondering why I messed up. I’ll have them bring in the bill and I will call Medicare. From: [mailto: ] On Behalf Of Seto Sent: Monday, February 08, 2010 7:19 PM To: Subject: Re: Coding question , Have you tried contacting Medicare directly and asking them why the charge was denied? It could be something as simple as the lab clerk entering the ICD9 code incorrectly. Seto South Pasadena, CA Thanks Carla, it looks like the code should be accepted. I may need to just go back to the lab and try and figure all this out. From: [mailto: ] On Behalf Of Carla Gibson Sent: Monday, February 08, 2010 4:41 PM To: Subject: Re: Coding question http://www.sonoraquest.com/documents/mdg-lipid_profile_cholesterol_testing.pdf Looks like your code should be good according to this document that lists all the codes that should be paid for a non-screening lipid panel. Carla To: Sent: Mon, February 8, 2010 12:03:52 PM Subject: Coding question Group, Over the past few months more and more of my patients have been forced to pay for their own labs due to my coding of the lab request. The vast majority of these are Medicare and involve follow up for high cholesterol coded with the 272.0 code. From what I understand the patient goes to the lab, is forced to sign an ABN (just in case), Medicare rejects the lab (reasons unknown to me as I am not involved in the process), and the patient is sent the bill. If the patient calls the lab to ask why they are getting a bill, they are told “your doctor gave us a code which was rejected by Medicare, so you need to call him and work it out.” Note: I never get a call from the lab saying “hey, this code you continually use does not work anymore” and when I call the lab(s), they say they cannot spend the time looking up why different codes were rejected or what will actually work. So essentially it appears to be a crap shoot to see if something gets paid, and if it doesn’t it is somehow my fault (at least to the patient). Has anyone else faced this? Can someone please point me in a direction as to where I might be able to do something simple like plug in a lab and an ICD code and see if the insurance will pay before I send my patients to get hundreds of dollars worth of labs they will then be responsible for? P.S. I am trying to refrain from going onto the soap box of how stupid and opaque this whole system is and how continually blaming everything on the primary care doc is not the way to ultimately keep costs down and encourage others to join us in choosing primary care. -- PATIENTS,please remember email may not be entirely secure and that Email is part of the medical record and is placed into the chart ( be careful what you say!) Email is best used for appointment making and brief questions Email replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2010 Report Share Posted February 9, 2010 It’s true that the system is stupid. But the bottom line is the patient has no control over the codes, the doctor picks the codes which makes the doctor responsible. The patient can’t change the codes. It’s always the doctor’s fault, everything is the doctor’s fault. I do apologize for things alot, tell my patients everything is my fault I tell them that if they get admitted and the nurse brings lunch and dumps the soup in their lap it is my fault.Perhaps I should cut that out-it is casuing JOhn Brady trouble. Now once the doctor has ascertained that they did indeed code correctly and it should be covered, then the patient can fight it directly with their insurance and with the lab. But until the correct code is used, they can’t do a thing other than pay. BTW, you are very lucky your lab accepts words. But that does open you to error as you are expecting a lab tech to interpret your words into codes. It’s a risk. PS: Chocolate gone, can’t send Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Jean Antonucci Sent: Tuesday, February 09, 2010 8:11 AM To: Subject: Re: Coding question The other thing that is fascinating here is that Brady gets blamed I bet Brady gets blmed becasue he has a relationship with the patient and they CAN FIND him to blame him He has aface and a voice and is a real person they can access. The lab is a mindless bureaucracy staffed by anonymous ever changing people handing papers back to people saying " yourdoctordiditwrong " eg " go away it would take work to problem solve this " Becasue Brady is an IMP he gets MORE stuff that flows downhill to him People expect him to do better becasue he always does. I bet this does not happen in big practices- I bet I bet patients there do not get the labs done, can';t find anyone to tell and disappaer without care How perverted Brady does good Brady gets punished. egads Send chocolate Jean On Mon, Feb 8, 2010 at 7:26 PM, Dr. Brady wrote: Not yet, I’m getting all this third hand from 2 angry patients who called this am wondering why I messed up. I’ll have them bring in the bill and I will call Medicare. From: [mailto: ] On Behalf Of Seto Sent: Monday, February 08, 2010 7:19 PM To: Subject: Re: Coding question , Have you tried contacting Medicare directly and asking them why the charge was denied? It could be something as simple as the lab clerk entering the ICD9 code incorrectly. Seto South Pasadena, CA Thanks Carla, it looks like the code should be accepted. I may need to just go back to the lab and try and figure all this out. From: [mailto: ] On Behalf Of Carla Gibson Sent: Monday, February 08, 2010 4:41 PM To: Subject: Re: Coding question http://www.sonoraquest.com/documents/mdg-lipid_profile_cholesterol_testing.pdf Looks like your code should be good according to this document that lists all the codes that should be paid for a non-screening lipid panel. Carla From: Dr. Brady To: Sent: Mon, February 8, 2010 12:03:52 PM Subject: Coding question Group, Over the past few months more and more of my patients have been forced to pay for their own labs due to my coding of the lab request. The vast majority of these are Medicare and involve follow up for high cholesterol coded with the 272.0 code. From what I understand the patient goes to the lab, is forced to sign an ABN (just in case), Medicare rejects the lab (reasons unknown to me as I am not involved in the process), and the patient is sent the bill. If the patient calls the lab to ask why they are getting a bill, they are told “your doctor gave us a code which was rejected by Medicare, so you need to call him and work it out.” Note: I never get a call from the lab saying “hey, this code you continually use does not work anymore” and when I call the lab(s), they say they cannot spend the time looking up why different codes were rejected or what will actually work. So essentially it appears to be a crap shoot to see if something gets paid, and if it doesn’t it is somehow my fault (at least to the patient). Has anyone else faced this? Can someone please point me in a direction as to where I might be able to do something simple like plug in a lab and an ICD code and see if the insurance will pay before I send my patients to get hundreds of dollars worth of labs they will then be responsible for? P.S. I am trying to refrain from going onto the soap box of how stupid and opaque this whole system is and how continually blaming everything on the primary care doc is not the way to ultimately keep costs down and encourage others to join us in choosing primary care. -- PATIENTS,please remember email may not be entirely secure and that Email is part of the medical record and is placed into the chart ( be careful what you say!) Email is best used for appointment making and brief questions Email replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org -- PATIENTS,please remember email may not be entirely secure and that Email is part of the medical record and is placed into the chart ( be careful what you say!)Email is best used for appointment making and brief questions Email replies can be expected within 24 hours-Please CALL if the matter is more urgent . 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Guest guest Posted February 9, 2010 Report Share Posted February 9, 2010 yes blame bradyfor a lithe kind of runner guy, he has big shouldersLynnTo: From: mkcl6@...Date: Tue, 9 Feb 2010 12:56:13 -0500Subject: Re: Coding question I can tell you from patient's side this is frustrating too. We get taken to collections almost monthly by Quest for labs done by my husband's oncologist, with no ABN signed, and then paid for by the insurance at 100%. I fight with them MONTHLY! It is amazing to me that they would send someone to collections (or even could) when there is no abn or consent for payment signed. Can I blame Brady, just for one of them, please? Kris In a message dated 2/9/2010 10:02:19 A.M. Eastern Standard Time, jbatlleoptonline (DOT) net writes: Is not true what you state. The patient pays for the insurance that he or she wants, allows the insurance company that he or she pays for to make all theses shenanigans, votes for representatives in the pocket of the insurers that rig the system against their benefit. This is a DEMOCRACY, a market driven one supposedly, and people get what they want and allow for. I am not at fault for the system; I tell patients that if they don’t like it they should vote or organize and stop paying for bad service. José from The Barrio From: [mailto: ] On Behalf Of Sent: Tuesday, February 09, 2010 8:31 AMTo: Subject: Re: Coding question On Tue, Feb 9, 2010 at 8:25 AM, Kathy Saradarian <qualityfphughes (DOT) net> wrote: It’s true that the system is stupid. But the bottom line is the patient has no control over the codes, the doctor picks the codes which makes the doctor responsible. The patient can’t change the codes. It’s always the doctor’s fault, everything is the doctor’s fault. I do apologize for things alot, tell my patients everything is my fault I tell them that if they get admitted and the nurse brings lunch and dumps the soup in their lap it is my fault.Perhaps I should cut that out-it is casuing JOhn Brady trouble. Now once the doctor has ascertained that they did indeed code correctly and it should be covered, then the patient can fight it directly with their insurance and with the lab. But until the correct code is used, they can’t do a thing other than pay. BTW, you are very lucky your lab accepts words. But that does open you to error as you are expecting a lab tech to interpret your words into codes. It’s a risk. PS: Chocolate gone, can’t send Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Sent: Tuesday, February 09, 2010 8:11 AM To: Subject: Re: Coding question The other thing that is fascinating here is that Brady gets blamedI bet Brady gets blmed becasue he has a relationship with the patient and they CAN FIND him to blame him He has aface and a voice and is a real person they can access. The lab is a mindless bureaucracy staffed by anonymous ever changing people handing papers back to people saying "yourdoctordiditwrong" eg "go away it would take work to problem solve this" Becasue Brady is an IMP he gets MORE stuff that flows downhill to him People expect him to do better becasue he always does. I bet this does not happen in big practices- I bet I bet patients there do not get the labs done, can';t find anyone to tell and disappaer without careHow perverted Brady does good Brady gets punished. egadsSend chocolateJean On Mon, Feb 8, 2010 at 7:26 PM, Dr. Brady <drbradythevillagedoctor (DOT) hrcoxmail.com> wrote: Not yet, I’m getting all this third hand from 2 angry patients who called this am wondering why I messed up. I’ll have them bring in the bill and I will call Medicare. From: [mailto: ] On Behalf Of SetoSent: Monday, February 08, 2010 7:19 PM To: Subject: Re: Coding question , Have you tried contacting Medicare directly and asking them why the charge was denied? It could be something as simple as the lab clerk entering the ICD9 code incorrectly. Seto South Pasadena, CA Thanks Carla, it looks like the code should be accepted. I may need to just go back to the lab and try and figure all this out. From: [mailto: ] On Behalf Of Carla GibsonSent: Monday, February 08, 2010 4:41 PMTo: Subject: Re: Coding question http://www.sonoraquest.com/documents/mdg-lipid_profile_cholesterol_testing.pdf Looks like your code should be good according to this document that lists all the codes that should be paid for a non-screening lipid panel. Carla From: Dr. Brady <drbradythevillagedoctor (DOT) hrcoxmail.com>To: Sent: Mon, February 8, 2010 12:03:52 PMSubject: Coding question Group, Over the past few months more and more of my patients have been forced to pay for their own labs due to my coding of the lab request. The vast majority of these are Medicare and involve follow up for high cholesterol coded with the 272.0 code. From what I understand the patient goes to the lab, is forced to sign an ABN (just in case), Medicare rejects the lab (reasons unknown to me as I am not involved in the process), and the patient is sent the bill. If the patient calls the lab to ask why they are getting a bill, they are told “your doctor gave us a code which was rejected by Medicare, so you need to call him and work it out.” Note: I never get a call from the lab saying “hey, this code you continually use does not work anymore” and when I call the lab(s), they say they cannot spend the time looking up why different codes were rejected or what will actually work. So essentially it appears to be a crap shoot to see if something gets paid, and if it doesn’t it is somehow my fault (at least to the patient). Has anyone else faced this? Can someone please point me in a direction as to where I might be able to do something simple like plug in a lab and an ICD code and see if the insurance will pay before I send my patients to get hundreds of dollars worth of labs they will then be responsible for? P.S. I am trying to refrain from going onto the soap box of how stupid and opaque this whole system is and how continually blaming everything on the primary care doc is not the way to ultimately keep costs down and encourage others to join us in choosing primary care. -- PATIENTS,please remember email may not be entirely secure and that Email is part of the medical record and is placed into the chart ( be careful what you say!)Email is best used for appointment making and brief questionsEmail replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org -- PATIENTS,please remember email may not be entirely secure and that Email is part of the medical record and is placed into the chart ( be careful what you say!)Email is best used for appointment making and brief questionsEmail replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org Your E-mail and More On-the-Go. Get Windows Live Hotmail Free. 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Guest guest Posted February 9, 2010 Report Share Posted February 9, 2010 Not so. Happens in the big practices too, including the last two I worked for. Just depends on how big. First the biller will call the lab and get the specifics. If big enough that they have coders then the billing department calls them and says "patient complaint, can you change the code?" and the coder will read the physicain note again and pick a code. If there is no coding department then the billing will pull the note and the pattients Problem List and sometimes even a list of what codes will cover that lab and walk it to the doctor. Doctor picks. Biller leaves and redoes it. But in an IMP world there is no such buffer. (But you are right -- more patients skip getting the labs done in the first place in the big practice.) Kris - I would check with the oncologist office -- I bet the doc is using one of those 4 digit codes instead of 5 digits or something like that. My prostate cancer patient s get PSA's every 3 months and it's never kicked back even tho' it's a "limited frequency" test. , I do the same thing for my patients. It's a hassle but fortunately hasn't happened very often for me. Fortunatley when I screw up I get forgiven by my patients. I like to think some of that is because I helped with this nonsense. To: Sent: Tue, February 9, 2010 12:56:13 PMSubject: Re: Coding question I can tell you from patient's side this is frustrating too. We get taken to collections almost monthly by Quest for labs done by my husband's oncologist, with no ABN signed, and then paid for by the insurance at 100%. I fight with them MONTHLY! It is amazing to me that they would send someone to collections (or even could) when there is no abn or consent for payment signed. Can I blame Brady, just for one of them, please? Kris In a message dated 2/9/2010 10:02:19 A.M. Eastern Standard Time, jbatlleoptonline (DOT) net writes: Is not true what you state. The patient pays for the insurance that he or she wants, allows the insurance company that he or she pays for to make all theses shenanigans, votes for representatives in the pocket of the insurers that rig the system against their benefit. This is a DEMOCRACY, a market driven one supposedly, and people get what they want and allow for. I am not at fault for the system; I tell patients that if they don’t like it they should vote or organize and stop paying for bad service. José from The Barrio From: Practiceimprovement 1yahoogroups (DOT) com [mailto:Practiceimp rovement1@ yahoogroups. com] On Behalf Of Sent: Tuesday, February 09, 2010 8:31 AMTo: Practiceimprovement 1yahoogroups (DOT) comSubject: Re: [Practiceimprovemen t1] Coding question On Tue, Feb 9, 2010 at 8:25 AM, Kathy Saradarian <qualityfphughes (DOT) net> wrote: It’s true that the system is stupid. But the bottom line is the patient has no control over the codes, the doctor picks the codes which makes the doctor responsible. The patient can’t change the codes. It’s always the doctor’s fault, everything is the doctor’s fault. I do apologize for things alot, tell my patients everything is my fault I tell them that if they get admitted and the nurse brings lunch and dumps the soup in their lap it is my fault.Perhaps I should cut that out-it is casuing JOhn Brady trouble. Now once the doctor has ascertained that they did indeed code correctly and it should be covered, then the patient can fight it directly with their insurance and with the lab. But until the correct code is used, they can’t do a thing other than pay. BTW, you are very lucky your lab accepts words. But that does open you to error as you are expecting a lab tech to interpret your words into codes. It’s a risk. PS: Chocolate gone, can’t send Kathy Saradarian, MD Branchville, NJ www.qualityfamilypr actice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: Practiceimprovement 1yahoogroups (DOT) com [mailto:Practiceimprovement 1yahoogroups (DOT) com] On Behalf Of Sent: Tuesday, February 09, 2010 8:11 AM To: Practiceimprovement 1yahoogroups (DOT) comSubject: Re: [Practiceimprovemen t1] Coding question The other thing that is fascinating here is that Brady gets blamedI bet Brady gets blmed becasue he has a relationship with the patient and they CAN FIND him to blame him He has aface and a voice and is a real person they can access. The lab is a mindless bureaucracy staffed by anonymous ever changing people handing papers back to people saying "yourdoctordiditwro n g" eg "go away it would take work to problem solve this" Becasue Brady is an IMP he gets MORE stuff that flows downhill to him People expect him to do better becasue he always does. I bet this does not happen in big practices- I bet I bet patients there do not get the labs done, can';t find anyone to tell and disappaer without careHow perverted Brady does good Brady gets punished. egadsSend chocolateJean On Mon, Feb 8, 2010 at 7:26 PM, Dr. Brady <drbrady@thevillaged octor.hrcoxmail. com> wrote: Not yet, I’m getting all this third hand from 2 angry patients who called this am wondering why I messed up. I’ll have them bring in the bill and I will call Medicare. From: Practiceimprovement 1yahoogroups (DOT) com [mailto:Practiceimprovement 1yahoogroups (DOT) com] On Behalf Of SetoSent: Monday, February 08, 2010 7:19 PM To: Practiceimprovement 1yahoogroups (DOT) comSubject: Re: [Practiceimprovemen t1] Coding question , Have you tried contacting Medicare directly and asking them why the charge was denied? It could be something as simple as the lab clerk entering the ICD9 code incorrectly. Seto South Pasadena, CA Thanks Carla, it looks like the code should be accepted. I may need to just go back to the lab and try and figure all this out. From: Practiceimprovement 1yahoogroups (DOT) com [mailto:@yahoogrou ps.com] On Behalf Of Carla GibsonSent: Monday, February 08, 2010 4:41 PMTo: Practiceimprovement 1yahoogroups (DOT) comSubject: Re: [Practiceimprovemen t1] Coding question http://www.sonoraqu est.com/document s/mdg-lipid_ profile_choleste rol_testing. pdf Looks like your code should be good according to this document that lists all the codes that should be paid for a non-screening lipid panel. Carla From: Dr. Brady <drbrady@thevillaged octor.hrcoxmail. com>To: Practiceimprovement 1yahoogroups (DOT) comSent: Mon, February 8, 2010 12:03:52 PMSubject: [Practiceimprovemen t1] Coding question Group, Over the past few months more and more of my patients have been forced to pay for their own labs due to my coding of the lab request. The vast majority of these are Medicare and involve follow up for high cholesterol coded with the 272.0 code. From what I understand the patient goes to the lab, is forced to sign an ABN (just in case), Medicare rejects the lab (reasons unknown to me as I am not involved in the process), and the patient is sent the bill. If the patient calls the lab to ask why they are getting a bill, they are told “your doctor gave us a code which was rejected by Medicare, so you need to call him and work it out.†Note: I never get a call from the lab saying “hey, this code you continually use does not work anymore†and when I call the lab(s), they say they cannot spend the time looking up why different codes were rejected or what will actually work. So essentially it appears to be a crap shoot to see if something gets paid, and if it doesn’t it is somehow my fault (at least to the patient). Has anyone else faced this? Can someone please point me in a direction as to where I might be able to do something simple like plug in a lab and an ICD code and see if the insurance will pay before I send my patients to get hundreds of dollars worth of labs they will then be responsible for? P.S. I am trying to refrain from going onto the soap box of how stupid and opaque this whole system is and how continually blaming everything on the primary care doc is not the way to ultimately keep costs down and encourage others to join us in choosing primary care. -- PATIENTS,please remember email may not be entirely secure and that Email is part of the medical record and is placed into the chart ( be careful what you say!)Email is best used for appointment making and brief questionsEmail replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org -- PATIENTS,please remember email may not be entirely secure and that Email is part of the medical record and is placed into the chart ( be careful what you say!)Email is best used for appointment making and brief questionsEmail replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2010 Report Share Posted February 9, 2010 I, too, use 272.4. I wonder if the 272.0 is being treated as a not specific enough code? Good luck. To: Sent: Mon, February 8, 2010 10:51:15 PMSubject: Re: Coding question , I use 272.4 I cant say what the difference is between the two codes. Just know that it seems to work and I have not fielded significant calls / complaints about it so I keep using it. I'm sorry about the rejections and the complaints. That is so frustrating. Mike Safran Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2010 Report Share Posted February 11, 2010 The lab can't tell you which code will work. They probably don't know for one, and it's probably not legal for another. The doctor does have to make the best choice s/he can for the given dx. That's all we can do. Dr. Brady wrote: > > Thanks Carla, it looks like the code should be accepted. I may need to > just go back to the lab and try and figure all this out. > > *From:* > [mailto: ] *On Behalf Of *Carla Gibson > *Sent:* Monday, February 08, 2010 4:41 PM > *To:* > *Subject:* Re: Coding question > > http://www.sonoraquest.com/documents/mdg-lipid_profile_cholesterol_testing.pdf > <http://www.sonoraquest.com/documents/mdg-lipid_profile_cholesterol_testing.pdf> > > Looks like your code should be good according to this document that > lists all the codes that should be paid for a non-screening lipid panel. > > Carla > > ------------------------------------------------------------------------ > > *From:* Dr. Brady > *To:* > *Sent:* Mon, February 8, 2010 12:03:52 PM > *Subject:* Coding question > > Group, > > Over the past few months more and more of my patients have been forced > to pay for their own labs due to my coding of the lab request. The > vast majority of these are Medicare and involve follow up for high > cholesterol coded with the 272.0 code. From what I understand the > patient goes to the lab, is forced to sign an ABN (just in case), > Medicare rejects the lab (reasons unknown to me as I am not involved > in the process), and the patient is sent the bill. If the patient > calls the lab to ask why they are getting a bill, they are told > “your doctor gave us a code which was rejected by Medicare, so you > need to call him and work it out.†Note: I never get a call from the > lab saying “hey, this code you continually use does not work > anymore†and when I call the lab(s), they say they cannot spend the > time looking up why different codes were rejected or what will > actually work. So essentially it appears to be a crap shoot to see if > something gets paid, and if it doesn’t it is somehow my fault (at > least to the patient). Has anyone else faced this? Can someone please > point me in a direction as to where I might be able to do something > simple like plug in a lab and an ICD code and see if the insurance > will pay before I send my patients to get hundreds of dollars worth of > labs they will then be responsible for? > > > > P.S. I am trying to refrain from going onto the soap box of how stupid > and opaque this whole system is and how continually blaming everything > on the primary care doc is not the way to ultimately keep costs down > and encourage others to join us in choosing primary care. > > Attachment: vcard [not shown] Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2010 Report Share Posted February 11, 2010 the lab does know which codes are acceptable for medicare fo a certain dx. They tell me that all the time. LIke I order a sed rate and say hopefully X dx NOPe they say. Hmm Y? nope. I say waddya got ?They say ABCD I say either well C fits or nope none is tue offer it to the patietn she might decline I think t hat kind of partnership is how health care SHOULD work Not this blaming stupid fragmenting make-the-other-person-the enemy stuff. alien. The lab can't tell you which code will work. They probably don't know for one, and it's probably not legal for another. The doctor does have to make the best choice s/he can for the given dx. That's all we can do. Dr. Brady wrote: > > Thanks Carla, it looks like the code should be accepted. I may need to > just go back to the lab and try and figure all this out. > > *From:* > [mailto: ] *On Behalf Of *Carla Gibson > *Sent:* Monday, February 08, 2010 4:41 PM > *To:* > *Subject:* Re: Coding question > > http://www.sonoraquest.com/documents/mdg-lipid_profile_cholesterol_testing.pdf > <http://www.sonoraquest.com/documents/mdg-lipid_profile_cholesterol_testing.pdf> > > Looks like your code should be good according to this document that > lists all the codes that should be paid for a non-screening lipid panel. > > Carla > > ---------------------------------------------------------- > > *From:* Dr. Brady > *To:* > *Sent:* Mon, February 8, 2010 12:03:52 PM > *Subject:* Coding question > > Group, > > Over the past few months more and more of my patients have been forced > to pay for their own labs due to my coding of the lab request. The > vast majority of these are Medicare and involve follow up for high > cholesterol coded with the 272.0 code. From what I understand the > patient goes to the lab, is forced to sign an ABN (just in case), > Medicare rejects the lab (reasons unknown to me as I am not involved > in the process), and the patient is sent the bill. If the patient > calls the lab to ask why they are getting a bill, they are told > “your doctor gave us a code which was rejected by Medicare, so you > need to call him and work it out.†Note: I never get a call from the > lab saying “hey, this code you continually use does not work > anymore†and when I call the lab(s), they say they cannot spend the > time looking up why different codes were rejected or what will > actually work. So essentially it appears to be a crap shoot to see if > something gets paid, and if it doesn’t it is somehow my fault (at > least to the patient). Has anyone else faced this? Can someone please > point me in a direction as to where I might be able to do something > simple like plug in a lab and an ICD code and see if the insurance > will pay before I send my patients to get hundreds of dollars worth of > labs they will then be responsible for? > > > > P.S. I am trying to refrain from going onto the soap box of how stupid > and opaque this whole system is and how continually blaming everything > on the primary care doc is not the way to ultimately keep costs down > and encourage others to join us in choosing primary care. > > -- PATIENTS,please remember email may not be entirely secure and that Email is part of the medical record and is placed into the chart ( be careful what you say!)Email is best used for appointment making and brief questions Email replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2010 Report Share Posted February 11, 2010 Ellen, That is the exact frustration. I code it, the lab gets the patient to sign an ABN, they put the code in, the code is rejected and the patient gets billed being told that it was the doctor’s fault for using the wrong code. I call the lab and they say, “sorry, we can’t tell you which code will work because we can’t make medical diagnoses and we only know when we put it in.†In the past, the lab would call and my nurse would just keep giving codes until we found one that worked. I believe the lab has made a decision to no longer provide this service and just roll with the system—even if the doc ends up getting blamed. The problem is not the lab, per se, but the stupid, ever changing rules of the insurance companies whose only goal is to make their shareholders happy. I realize this, but my patients don’t. And honestly, in this tight economy, I don’t blame my patients one bit for getting mad and confused and frustrated. My dilemma is that I don’t want to be the whipping boy for all the other dysfunctional aspects of the health care system but I also feel obligated to be an advocate for my patients. It is this underlying conflict which drives me nuts. From: [mailto: ] On Behalf Of Ellen son Sent: Thursday, February 11, 2010 2:36 AM To: Subject: Re: Coding question The lab can't tell you which code will work. They probably don't know for one, and it's probably not legal for another. The doctor does have to make the best choice s/he can for the given dx. That's all we can do. Dr. Brady wrote: > > Thanks Carla, it looks like the code should be accepted. I may need to > just go back to the lab and try and figure all this out. > > *From:* > [mailto: ] *On Behalf Of *Carla Gibson > *Sent:* Monday, February 08, 2010 4:41 PM > *To:* > *Subject:* Re: Coding question > > http://www.sonoraquest.com/documents/mdg-lipid_profile_cholesterol_testing.pdf > <http://www.sonoraquest.com/documents/mdg-lipid_profile_cholesterol_testing.pdf> > > Looks like your code should be good according to this document that > lists all the codes that should be paid for a non-screening lipid panel. > > Carla > > ---------------------------------------------------------- > > *From:* Dr. Brady > *To:* > *Sent:* Mon, February 8, 2010 12:03:52 PM > *Subject:* Coding question > > Group, > > Over the past few months more and more of my patients have been forced > to pay for their own labs due to my coding of the lab request. The > vast majority of these are Medicare and involve follow up for high > cholesterol coded with the 272.0 code. From what I understand the > patient goes to the lab, is forced to sign an ABN (just in case), > Medicare rejects the lab (reasons unknown to me as I am not involved > in the process), and the patient is sent the bill. If the patient > calls the lab to ask why they are getting a bill, they are told > “your doctor gave us a code which was rejected by Medicare, so you > need to call him and work it out.†Note: I never get a call from the > lab saying “hey, this code you continually use does not work > anymore†and when I call the lab(s), they say they cannot spend the > time looking up why different codes were rejected or what will > actually work. So essentially it appears to be a crap shoot to see if > something gets paid, and if it doesn’t it is somehow my fault (at > least to the patient). Has anyone else faced this? Can someone please > point me in a direction as to where I might be able to do something > simple like plug in a lab and an ICD code and see if the insurance > will pay before I send my patients to get hundreds of dollars worth of > labs they will then be responsible for? > > > > P.S. I am trying to refrain from going onto the soap box of how stupid > and opaque this whole system is and how continually blaming everything > on the primary care doc is not the way to ultimately keep costs down > and encourage others to join us in choosing primary care. > > Quote Link to comment Share on other sites More sharing options...
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