Guest guest Posted February 11, 2010 Report Share Posted February 11, 2010 , I’m sorry but I don’t believe the lab doesn’t know. And they are just bypassing insurance by having the patient sign the AB N. Is there even proof they are billing insurance first? I would talk with manager and tell them you are sending business elsewhere unless they shape up. It is there job to know what is covered just like it is for us. We can’t get away with that. They know. And 272.0 is definitely covered for a lipid panel. It also chem. Scan. It may even justify a thyroid panel. It won ‘t cover a CBC w diff though. There is something wrong with the lab in this case, not your coding. 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: Thursday, February 11, 2010 8:08 AM To: Subject: RE: Coding question 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...
Guest guest Posted February 11, 2010 Report Share Posted February 11, 2010 Me too. The lab will tell me what code will work -- if I get the right person on the phone. To: Sent: Thu, February 11, 2010 8:01:43 AMSubject: Re: Coding question 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 declineI 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. On Thu, Feb 11, 2010 at 2:35 AM, Ellen son <nellegreen@earthlin k.net> wrote: 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:* Practiceimprovement 1yahoogroups (DOT) com > [mailto:Practiceimprovement 1yahoogroups (DOT) com] *On Behalf Of *Carla Gibson> *Sent:* Monday, February 08, 2010 4:41 PM> *To:* Practiceimprovement 1yahoogroups (DOT) com> *Subject:* Re: [Practiceimprovemen t1] Coding question>> http://www.sonoraqu est.com/document s/mdg-lipid_ profile_choleste rol_testing. pdf > <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) com> *Sent:* Mon, February 8, 2010 12:03:52 PM> *Subject:* [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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2010 Report Share Posted February 11, 2010 Drop that lab unless they change their behavior. Our local hospital lab doesn't require ABNs of the patients. They send a form to the doc if Medicare rejects the dx. Attached to the form is a list of diagnoses acceptable to Medicare for this test. If this lab won't do the same for you, then send your lab business elsewhere.  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 <drbradythevillagedoctor (DOT) hrcoxmail.com> > *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 11, 2010 Report Share Posted February 11, 2010 I just called my lab They said private insurers are more trouble and often require things to be called screening before they will pay Which of course is fraud if it is not screening She said but 272.0 is fine for hypercholesterolemia The trouble is indeed the insurers mucking with you They call a service covered but it may not be unless you lie This one is an area where you can;t really lie If the guy is on zocor you cannot say screening IT is like the patient who just wanted an IUD SHe called insurance in front of me It was " covered " but it turns out that to buy it costs oh 400.00 whatever ,and they wil l pay me 150.00 They call that covered because the patient cannot be billed an does not have to pay ITs the marketing manipulation So to put that IUDin I would have to pay 250.00 I tend to do this in front of patietns. I suppose you could do that Anyway is right Talk to the lab manager or ditch the lab They a re inappropriate. I admit I have mostly medicare here and see little of this --with medicare you look it up my lab snet me what they use : PDF] 2004400 October 2004, Change Report and NCD Coding Policy Manual <http://www.cms.hhs.gov/CoverageGenInfo/Downloads/manual201001.pdf> .... January 10 Changes - Red NCD Manual Changes Date Reason Release Change Edit The following section represents NCD Manual updates for January 2010. .... www.cms.hhs.gov/CoverageGenInfo/Downloads/manual201001.pdf - 2010-01-27 - Text Version <search?q=cache:3iVwsXHd4_wJ:www.cms.hhs.gov/CoverageGenInfo/Downloads/manua l201001.pdf+NCD+FOR+2010 & site=cms_collection & output=xml_no_dtd & client=cms_fr ontend & proxystylesheet=cms_frontend & ie=UTF-8 & access=p & oe=UTF-8> Try this link, hope it works, I could open this one 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. > > -- 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 Thank you for the links Jean. To: Sent: Thu, February 11, 2010 9:39:19 AMSubject: Re: Coding question I just called my lab They said private insurers are more trouble and often require things to be called screening before they will pay Which of course is fraud if it is not screening She said but 272.0 is fine for hypercholesterolemi a The trouble is indeed the insurers mucking with you They call a service covered but it may not be unless you lie This one is an area where you can;t really lie If the guy is on zocor you cannot say screening IT is like the patient who just wanted an IUD SHe called insurance in front of me It was"covered" but it turns out that to buy it costs oh 400.00 whatever ,and they wil l pay me 150.00 They call that covered because the patient cannot be billed an does not have to pay ITs the marketing manipulation So to put that IUDin I would have to pay 250.00 I tend to do this in front of patietns. I suppose you could do that Anyway is right Talk to the lab manager or ditch the lab They a re inappropriate. I admit I have mostly medicare here and see little of this --with medicare you look it up my lab snet me what they use :PDF] 2004400 October 2004, Change Report and NCD Coding Policy Manual<http://www.cms. hhs.gov/Coverage GenInfo/Download s/manual201001. pdf>... January 10 Changes - Red NCD Manual Changes Date Reason Release ChangeEdit The following section represents NCD Manual updates for January 2010.... www.cms.hhs. gov/CoverageGenI nfo/Downloads/ manual201001. pdf - 2010-01-27- Text Version<search?q=cache: 3iVwsXHd4_ wJ:www.cms.hhs. gov/CoverageGenI nfo/Downloads/ manual201001.pdf+ NCD+FOR+2010 & site=cms_collection & output=xml_no_ dtd & client=cms_frontend & proxystylesheet= cms_frontend & ie=UTF-8 & access=p & oe=UTF-8>Try this link, hope it works, I could open this one On Thu, Feb 11, 2010 at 8:08 AM, Dr. Brady <drbrady@thevillaged octor.hrcoxmail. com> wrote: 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: Practiceimprovement 1yahoogroups (DOT) com [mailto:Practiceimprovement 1yahoogroups (DOT) com] On Behalf Of Ellen sonSent: Thursday, February 11, 2010 2:36 AM To: Practiceimprovement 1yahoogroups (DOT) comSubject: Re: [Practiceimprovemen t1] 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:* Practiceimprovement 1yahoogroups (DOT) com > [mailto:Practiceimprovement 1yahoogroups (DOT) com] *On Behalf Of *Carla Gibson> *Sent:* Monday, February 08, 2010 4:41 PM> *To:* Practiceimprovement 1yahoogroups (DOT) com> *Subject:* Re: [Practiceimprovemen t1] Coding question>> http://www.sonoraqu est.com/document s/mdg-lipid_ profile_choleste rol_testing. pdf > <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) com> *Sent:* Mon, February 8, 2010 12:03:52 PM> *Subject:* [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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2010 Report Share Posted February 11, 2010 Thats the same problem we've been having with Quest labs. We are in the process of switching to Spectrum. The Robbins Health Alliance 1324 Rockbridge Road, SW Stone Mountain, GA 30087 PH: Fax: www.robbinshealth.com Your first choice for Internal and Holistic Medicine.>> 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:Practiceimprovement 1yahoogroups (DOT) com] *On Behalf Of *Carla Gibson> *Sent:* Monday, February 08, 2010 4:41 PM> *To:* Practiceimprovement 1yahoogroups (DOT) com> *Subject:* Re: [Practiceimprovemen t1] Coding question>> http://www.sonoraqu est.com/document s/mdg-lipid_ profile_choleste rol_testing. pdf > <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) com> *Sent:* Mon, February 8, 2010 12:03:52 PM> *Subject:* [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.>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2010 Report Share Posted February 12, 2010 , The lack of transparency is what is crazy. If you (easily) knew that X wasn't covered and could give the patient a choice to pay Y or not, patients could make decisions. The university clinic I used to work at would not draw labs on Medicare patients without an ABN signed, no matter what the lab. You could argue that they (the lab) shouldn't be at risk for the cost either. I used to have a coding sheet that they had given us for which codes were acceptable to Medicare for which labs. Maybe someone can come up with one. This happens to me also, although recently I have had a few requests from the billing office at Quest for a more acceptable code (no clue as to what that is though). It would be nice if the lab gave clues, but I don't really think it is their job. But, of course, not ours either. It is a manifestation of the complete lack of transparency and chaos in our health care system. I just looked up on the Care360 online ordering for Quest and 272.0 does require more specificity: 272 - dis of lipoid metabolism* = Requires Higher Specificity 2720 - pure hypercholesterolem 2721 - pure hyperglyceridemia2722 - mixed hyperlipidemia 2723 - hyperchylomicronemia2724 - hyperlipidemia nec/nos 2725 - lipoprotein deficiencies2726 - lipodystrophy 2727 - lipidoses2728 - lipoid metabol dis nec 2729 - lipoid metabol dis nos I do not like retyping the info (rather print order from my EMR), but the on-line system for Quest does work pretty well and avoids the forgotten lab slip or misplaced fax. I like being able to look up labs on-line. SharonSharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2010 Report Share Posted February 12, 2010 We use labcorps. Our emr has an interface, and will let you know if you need an ABN as you are creating the order. If you do, they have an electronic link to a list of codes that are acceptable, to avoid the ABN, or you can print out the ABN immediately and get it signed. They also provide a book with all the information. I hate ABN's, but find this only requires about 30 seconds to complete. I guess Quest does the same, but the interface is $300/month maintainence, so we don't do it. From: [ ] On Behalf Of Dr. Sharon McCoy [docsharon@...] Sent: Thursday, February 11, 2010 8:49 PM To: Subject: Re: Coding question , The lack of transparency is what is crazy. If you (easily) knew that X wasn't covered and could give the patient a choice to pay Y or not, patients could make decisions. The university clinic I used to work at would not draw labs on Medicare patients without an ABN signed, no matter what the lab. You could argue that they (the lab) shouldn't be at risk for the cost either. I used to have a coding sheet that they had given us for which codes were acceptable to Medicare for which labs. Maybe someone can come up with one. This happens to me also, although recently I have had a few requests from the billing office at Quest for a more acceptable code (no clue as to what that is though). It would be nice if the lab gave clues, but I don't really think it is their job. But, of course, not ours either. It is a manifestation of the complete lack of transparency and chaos in our health care system. I just looked up on the Care360 online ordering for Quest and 272.0 does require more specificity: 272 - dis of lipoid metabolism* = Requires Higher Specificity 2720 - pure hypercholesterolem 2721 - pure hyperglyceridemia 2722 - mixed hyperlipidemia 2723 - hyperchylomicronemia 2724 - hyperlipidemia nec/nos 2725 - lipoprotein deficiencies 2726 - lipodystrophy 2727 - lipidoses 2728 - lipoid metabol dis nec 2729 - lipoid metabol dis nos I do not like retyping the info (rather print order from my EMR), but the on-line system for Quest does work pretty well and avoids the forgotten lab slip or misplaced fax. I like being able to look up labs on-line. Sharon Sharon McCoy MD Renaissance Family Medicine 10 McClintock Court; Irvine, CA 92617 PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2010 Report Share Posted February 12, 2010 Good point, Jim. I think the Quest cost varies depending on your volume (they were going to give it to me free until they found out how low volume I was). The Care 360 on-line system from Quest is free though, but doesn't directly interface to my EMR. Sharon We use labcorps. Our emr has an interface, and will let you know if you need an ABN as you are creating the order. If you do, they have an electronic link to a list of codes that are acceptable, to avoid the ABN, or you can print out the ABN immediately and get it signed. They also provide a book with all the information. I hate ABN's, but find this only requires about 30 seconds to complete. I guess Quest does the same, but the interface is $300/month maintainence, so we don't do it. From: [ ] On Behalf Of Dr. Sharon McCoy [docsharon@...] Sent: Thursday, February 11, 2010 8:49 PMTo: Subject: Re: Coding question , The lack of transparency is what is crazy. If you (easily) knew that X wasn't covered and could give the patient a choice to pay Y or not, patients could make decisions. The university clinic I used to work at would not draw labs on Medicare patients without an ABN signed, no matter what the lab. You could argue that they (the lab) shouldn't be at risk for the cost either. I used to have a coding sheet that they had given us for which codes were acceptable to Medicare for which labs. Maybe someone can come up with one. This happens to me also, although recently I have had a few requests from the billing office at Quest for a more acceptable code (no clue as to what that is though). It would be nice if the lab gave clues, but I don't really think it is their job. But, of course, not ours either. It is a manifestation of the complete lack of transparency and chaos in our health care system. I just looked up on the Care360 online ordering for Quest and 272.0 does require more specificity: 272 - dis of lipoid metabolism* = Requires Higher Specificity 2720 - pure hypercholesterolem2721 - pure hyperglyceridemia 2722 - mixed hyperlipidemia2723 - hyperchylomicronemia2724 - hyperlipidemia nec/nos 2725 - lipoprotein deficiencies2726 - lipodystrophy2727 - lipidoses 2728 - lipoid metabol dis nec2729 - lipoid metabol dis nos I do not like retyping the info (rather print order from my EMR), but the on-line system for Quest does work pretty well and avoids the forgotten lab slip or misplaced fax. I like being able to look up labs on-line. SharonSharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com -- Sharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2010 Report Share Posted February 12, 2010 Yah, I have that on my machine, but I can write faster than the multiple screens. I try not to use them From: [ ] On Behalf Of Dr. Sharon McCoy [docsharon@...] Sent: Friday, February 12, 2010 12:40 PM To: Subject: Re: Coding question Good point, Jim. I think the Quest cost varies depending on your volume (they were going to give it to me free until they found out how low volume I was). The Care 360 on-line system from Quest is free though, but doesn't directly interface to my EMR. Sharon On 2/12/10, Kennedy, Jim <jim.kennedyucdenver (DOT) edu> wrote: We use labcorps. Our emr has an interface, and will let you know if you need an ABN as you are creating the order. If you do, they have an electronic link to a list of codes that are acceptable, to avoid the ABN, or you can print out the ABN immediately and get it signed. They also provide a book with all the information. I hate ABN's, but find this only requires about 30 seconds to complete. I guess Quest does the same, but the interface is $300/month maintainence, so we don't do it. From: [ ] On Behalf Of Dr. Sharon McCoy [docsharon] Sent: Thursday, February 11, 2010 8:49 PM To: Subject: Re: Coding question , The lack of transparency is what is crazy. If you (easily) knew that X wasn't covered and could give the patient a choice to pay Y or not, patients could make decisions. The university clinic I used to work at would not draw labs on Medicare patients without an ABN signed, no matter what the lab. You could argue that they (the lab) shouldn't be at risk for the cost either. I used to have a coding sheet that they had given us for which codes were acceptable to Medicare for which labs. Maybe someone can come up with one. This happens to me also, although recently I have had a few requests from the billing office at Quest for a more acceptable code (no clue as to what that is though). It would be nice if the lab gave clues, but I don't really think it is their job. But, of course, not ours either. It is a manifestation of the complete lack of transparency and chaos in our health care system. I just looked up on the Care360 online ordering for Quest and 272.0 does require more specificity: 272 - dis of lipoid metabolism* = Requires Higher Specificity 2720 - pure hypercholesterolem 2721 - pure hyperglyceridemia 2722 - mixed hyperlipidemia 2723 - hyperchylomicronemia 2724 - hyperlipidemia nec/nos 2725 - lipoprotein deficiencies 2726 - lipodystrophy 2727 - lipidoses 2728 - lipoid metabol dis nec 2729 - lipoid metabol dis nos I do not like retyping the info (rather print order from my EMR), but the on-line system for Quest does work pretty well and avoids the forgotten lab slip or misplaced fax. I like being able to look up labs on-line. Sharon Sharon McCoy MD Renaissance Family Medicine 10 McClintock Court; Irvine, CA 92617 PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com -- Sharon McCoy MD Renaissance Family Medicine 10 McClintock Court; Irvine, CA 92617 PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 13, 2010 Report Share Posted February 13, 2010 Are they on meds for the lipid disorder. We started adding V58.69 for long term use of med and got rid of a lot of the issues. Beth Sullivan, DO Ridgeway Family Practice Commerce, GA 30529 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 13, 2010 Report Share Posted February 13, 2010 Could the problem be that the lab is non-participating? Beth Sullivan, DO Ridgeway Family Practice Commerce, GA 30529 From: [mailto: ] On Behalf Of Kathy Saradarian Sent: Tuesday, February 09, 2010 8:25 AM To: Subject: RE: Coding question 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 13, 2010 Report Share Posted February 13, 2010 I don't understand why the pts are angry. They made the choice to have medicare or another third party payor. Not the physician. Physicians bill third party payors as a service to pts. Pts are ultimatly responsible for the cost. NOT physicians, NOT government (really thier neighboors or taxpayers). As for the lab passing the buck and blaming the physician. How unprofessional. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 14, 2010 Report Share Posted February 14, 2010 --- As much as I would like to lab tell me what code to use, it's really a clinical matter and no one on the tel in a lab is qualified to make the decision. So it is up to the doctor, as it should be. Do we need some help, some coaching to understand how best to use the codes for various issues? Yes, but it can't be the lab that helps us. Many thing are dysfunctional in the system but it's not the lab's fault for this one. The lab just does the service of running the tests. The insurance companies perhaps ought to offer better explanations about what they cover and why, which codes for which diagnoses and why. That would be helpful. I have never had a problem with 272.4 for cholesterol. The ICD-9 book is an international standard, probably not even written by Americans which is why it seems odd at times and it's a puzzle to look things up. And I can imagine that the codes may be interpreted differently in different countries. Ellen Dr. Brady wrote: > > 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:%40yahoogroups.com> > > [mailto: > <mailto:%40yahoogroups.com>] *On Behalf Of *Carla > Gibson > > *Sent:* Monday, February 08, 2010 4:41 PM > > *To:* > <mailto:%40yahoogroups.com> > > *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> > > > > <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 <drbrady@... > <mailto:drbrady%40thevillagedoctor.hrcoxmail.com>> > > *To:* > <mailto:%40yahoogroups.com> > > *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 14, 2010 Report Share Posted February 14, 2010 Is insurance issue. Lab can tell which will be covered. Disguised as a "fraud control," this has become an insurance denial issue. Cruddy M * 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 14, 2010 Report Share Posted February 14, 2010 Ellen, It stopped being a clinical matter a long time ago. It is a matter of administrative bs. I need to know what code to use because I can no longer write Hypercholesterolemia on the order and get it done. NOPE, we must use ICD coding and insurances have decided which codes work and how often and will deny based on arcane and stupid rules and it is no longer a clinical matter but no one will own up to the stupidity because the more they run the patients around and the more they can deflect patient anger away from them and the more money they can save. “Oh, your stupid doc just coded it wrong. Have him resubmit the bill in triplicate with 20 different codes on special paper and we will gladly relook at the claim.†It is stupid. It is crazy. And it is NOT clinical. By the way, the AMA created and updates the ICD coding system. The last article I saw they make twice as much from selling these codes as they do from membership fees. So they are the ones who started this insanity. Of course, the insurance companies just refined it to work to their advantage even if it brings the entire system to its knees. From: [mailto: ] On Behalf Of Ellen son Sent: Saturday, February 13, 2010 7:28 PM To: Subject: Re: Coding question --- As much as I would like to lab tell me what code to use, it's really a clinical matter and no one on the tel in a lab is qualified to make the decision. So it is up to the doctor, as it should be. Do we need some help, some coaching to understand how best to use the codes for various issues? Yes, but it can't be the lab that helps us. Many thing are dysfunctional in the system but it's not the lab's fault for this one. The lab just does the service of running the tests. The insurance companies perhaps ought to offer better explanations about what they cover and why, which codes for which diagnoses and why. That would be helpful. I have never had a problem with 272.4 for cholesterol. The ICD-9 book is an international standard, probably not even written by Americans which is why it seems odd at times and it's a puzzle to look things up. And I can imagine that the codes may be interpreted differently in different countries. Ellen Dr. Brady wrote: > > 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 systemâ€â€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:%40yahoogroups.com> > > [mailto: > <mailto:%40yahoogroups.com>] *On Behalf Of *Carla > Gibson > > *Sent:* Monday, February 08, 2010 4:41 PM > > *To:* > <mailto:%40yahoogroups.com> > > *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> > > > > <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 <drbrady@... > <mailto:drbrady%40thevillagedoctor.hrcoxmail.com>> > > *To:* > <mailto:%40yahoogroups.com> > > *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 14, 2010 Report Share Posted February 14, 2010 If I draw blood and send to a lab that requires payment up front (could be paid by doctor or by patient), will insurance reimburse (doctor or patient) for the cost? (prices are much lower than hospital, etc) Could the problem be that the lab is non-participating? Beth Sullivan, DO Ridgeway Family Practice Commerce, GA 30529 From: [mailto: ] On Behalf Of Kathy Saradarian Sent: Tuesday, February 09, 2010 8:25 AMTo: Subject: RE: Coding question 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 Sent: Tuesday, February 09, 2010 8:11 AMTo: 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 care How perverted Brady does good Brady gets punished. egadsSend chocolateJean 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 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 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 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 14, 2010 Report Share Posted February 14, 2010 Has any one passed this information to our representative government? The way these comments have been written shows the genuine concern FPs have for their patients and the lose lose situation for us docs and patients. Surely we can find a way to offer less duplicative services than to start a Medicare only clinic. Think how much time we spend stressing over these issues and trying to control our patients BP while being good listeners. WHO SHOULD WE BE TALKING TO? We all know this is not working but the patients and we docs are the ones trying the hardest to solve the problems. Carolyn ---As much as I would like to lab tell me what code to use, it's really a clinical matter and no one on the tel in a lab is qualified to make the decision. So it is up to the doctor, as it should be. Do we need some help, some coaching to understand how best to use the codes for various issues? Yes, but it can't be the lab that helps us. Many thing are dysfunctional in the system but it's not the lab's fault for this one. The lab just does the service of running the tests. The insurance companies perhaps ought to offer better explanations about what they cover and why, which codes for which diagnoses and why. That would be helpful. I have never had a problem with 272.4 for cholesterol. The ICD-9 book is an international standard, probably not even written by Americans which is why it seems odd at times and it's a puzzle to look things up. And I can imagine that the codes may be interpreted differently in different countries. EllenDr. Brady wrote:>> 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:%40yahoogroups.com> > > [mailto: > <mailto:%40yahoogroups.com>] *On Behalf Of *Carla > Gibson> > *Sent:* Monday, February 08, 2010 4:41 PM> > *To:* > <mailto:%40yahoogroups.com> > > *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> >> > > <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 <drbrady@... > <mailto:drbrady%40thevillagedoctor.hrcoxmail.com>>> > *To:* > <mailto:%40yahoogroups.com>> > *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 14, 2010 Report Share Posted February 14, 2010 1) Change labs 2) Insist on talking DIRECTLY TO the lab director as THEY WILL NOT BE GETTING PAID BY MANY OF THESE PTS. PS hospital lab sends me occasionally a request for DX, NOT the code, if they won't get through. Suspect sadly this is a private lab that wants the cash............... Matt in Western PA * 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 15, 2010 Report Share Posted February 15, 2010 Hey like Jean's suggestion to separate the for profit consultants from the AAFP perhaps we should start screaming that the AMA sell off, and separate out from the code creating people so they can finally properly represent doctors and patients instead of their own pockets.... To: Sent: Sat, February 13, 2010 9:11:02 PMSubject: RE: Coding question Ellen, It stopped being a clinical matter a long time ago. It is a matter of administrative bs. I need to know what code to use because I can no longer write Hypercholesterolemi a on the order and get it done. NOPE, we must use ICD coding and insurances have decided which codes work and how often and will deny based on arcane and stupid rules and it is no longer a clinical matter but no one will own up to the stupidity because the more they run the patients around and the more they can deflect patient anger away from them and the more money they can save. “Oh, your stupid doc just coded it wrong. Have him resubmit the bill in triplicate with 20 different codes on special paper and we will gladly relook at the claim.†It is stupid. It is crazy. And it is NOT clinical. By the way, the AMA created and updates the ICD coding system. The last article I saw they make twice as much from selling these codes as they do from membership fees. So they are the ones who started this insanity. Of course, the insurance companies just refined it to work to their advantage even if it brings the entire system to its knees. From: Practiceimprovement 1yahoogroups (DOT) com [mailto:Practiceimp rovement1@ yahoogroups. com] On Behalf Of Ellen sonSent: Saturday, February 13, 2010 7:28 PMTo: Practiceimprovement 1yahoogroups (DOT) comSubject: Re: [Practiceimprovemen t1] Coding question ---As much as I would like to lab tell me what code to use, it's really a clinical matter and no one on the tel in a lab is qualified to make the decision. So it is up to the doctor, as it should be. Do we need some help, some coaching to understand how best to use the codes for various issues? Yes, but it can't be the lab that helps us. Many thing are dysfunctional in the system but it's not the lab's fault for this one.The lab just does the service of running the tests. The insurance companies perhaps ought to offer better explanations about what they cover and why, which codes for which diagnoses and why. That would be helpful. I have never had a problem with 272.4 for cholesterol. The ICD-9 book is an international standard, probably not even written by Americans which is why it seems odd at times and it's a puzzle to look things up. And I can imagine that the codes may be interpreted differently in different countries.EllenDr. Brady wrote:>> 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 systemâ€â€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:* Practiceimprovement 1yahoogroups (DOT) com > [mailto:Practiceimprovement 1yahoogroups (DOT) com] *On Behalf Of *Ellen > son> *Sent:* Thursday, February 11, 2010 2:36 AM> *To:* Practiceimprovement 1yahoogroups (DOT) com> *Subject:* Re: [Practiceimprovemen t1] 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:* Practiceimprovement 1yahoogroups (DOT) com > <mailto:Practiceimpr ovement1% 40yahoogroups. com>> > [mailto:Practiceimprovement 1yahoogroups (DOT) com > <mailto:Practiceimpr ovement1% 40yahoogroups. com>] *On Behalf Of *Carla > Gibson> > *Sent:* Monday, February 08, 2010 4:41 PM> > *To:* Practiceimprovement 1yahoogroups (DOT) com > <mailto:Practiceimpr ovement1% 40yahoogroups. com>> > *Subject:* Re: [Practiceimprovemen t1] Coding question> >> > > http://www.sonoraqu est.com/document s/mdg-lipid_ profile_choleste rol_testing. pdf > <http://www.sonoraqu est.com/document s/mdg-lipid_ profile_choleste rol_testing. pdf> >> > > <http://www.sonoraqu est.com/document s/mdg-lipid_ profile_choleste rol_testing. pdf > <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 > <mailto:drbrady% 40thevillagedoct or.hrcoxmail. com>>> > *To:* Practiceimprovement 1yahoogroups (DOT) com > <mailto:Practiceimpr ovement1% 40yahoogroups. com>> > *Sent:* Mon, February 8, 2010 12:03:52 PM> > *Subject:* [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.â€Â Note: I never get a call > from the> > lab saying “hey, this code you continually use does not work> > anymoreâ€Â 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 17, 2010 Report Share Posted February 17, 2010 It's a fine point, but I think the ICD-9 is actually not owned by the AMA. The ICD-9-CM is maintained by the federal government/CMS with advise from private and public sectors. http://www.cdc.gov/nchs/icd/icd9cm.htm This is why you can get copies of the whole thing on-line in many places for free, such as for example, if you wanted to import the entire set of codes en-masse into your own home made EMR. However the CPT system - the codes for the procedures we bill for that is associated on a claim with the ICD-9 codes, IS owned by the AMA, which jealously guards it. A few years ago, a number of web sites had put up copies of the entire database of CPT codes you could copy and paste, but the AMA has gone around systematically and forced them to all be pretty much removed. They do provide one site where you can look up one CPT code at a time, but they have made it very near impossible to download the entire database of codes from anywhere. Obviously this is to protect their financial interest in licenses they sell to those who need to use the codes. We have to pay even if we are members of the AMA for a copy of the codes, either in a book or on a disk. > By the way, the AMA created and updates the ICD coding system. The last article I saw they make twice as much from selling these codes as they do from membership fees. So they are the ones who started this insanity. Of course, the insurance companies just refined it to work to their advantage even if it brings the entire system to its knees. > >  > From:Practiceimprovement 1yahoogroups (DOT) com [mailto:Practiceimp rovement1@ yahoogroups. com] On Behalf Of Ellen son > Sent: Saturday, February 13, 2010 7:28 PM > To: Practiceimprovement 1yahoogroups (DOT) com > Subject: Re: [Practiceimprovemen t1] Coding question >  >  > --- > > As much as I would like to lab tell me what code to use, it's really a > clinical matter and no one on the tel in a lab is qualified to make the > decision. So it is up to the doctor, as it should be. Do we need some > help, some coaching to understand how best to use the codes for various > issues? Yes, but it can't be the lab that helps us. Many thing are > dysfunctional in the system but it's not the lab's fault for this one. > The lab just does the service of running the tests. The insurance > companies perhaps ought to offer better explanations about what they > cover and why, which codes for which diagnoses and why. That would be > helpful. I have never had a problem with 272.4 for cholesterol. The > ICD-9 book is an international standard, probably not even written by > Americans which is why it seems odd at times and it's a puzzle to look > things up. And I can imagine that the codes may be interpreted > differently in different countries. > > Ellen > > Dr. Brady wrote: > > > > 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 systemâ€â€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:* Practiceimprovement 1yahoogroups (DOT) com > > [mailto:Practiceimprovement 1yahoogroups (DOT) com] *On Behalf Of *Ellen > > son > > *Sent:* Thursday, February 11, 2010 2:36 AM > > *To:* Practiceimprovement 1yahoogroups (DOT) com > > *Subject:* Re: [Practiceimprovemen t1] 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:* Practiceimprovement 1yahoogroups (DOT) com > > <mailto:Practiceimpr ovement1% 40yahoogroups. com> > > > [mailto:Practiceimprovement 1yahoogroups (DOT) com > > <mailto:Practiceimpr ovement1% 40yahoogroups. com>] *On Behalf Of *Carla > > Gibson > > > *Sent:* Monday, February 08, 2010 4:41 PM > > > *To:* Practiceimprovement 1yahoogroups (DOT) com > > <mailto:Practiceimpr ovement1% 40yahoogroups. com> > > > *Subject:* Re: [Practiceimprovemen t1] Coding question > > > > > > > > http://www.sonoraqu est.com/document s/mdg-lipid_ profile_choleste rol_testing. pdf > > <http://www.sonoraqu est.com/document s/mdg-lipid_ profile_choleste rol_testing. pdf> > > > > > > > <http://www.sonoraqu est.com/document s/mdg-lipid_ profile_choleste rol_testing. pdf > > <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 > > <mailto:drbrady% 40thevillagedoct or.hrcoxmail. com>> > > > *To:* Practiceimprovement 1yahoogroups (DOT) com > > <mailto:Practiceimpr ovement1% 40yahoogroups. com> > > > *Sent:* Mon, February 8, 2010 12:03:52 PM > > > *Subject:* [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.â€Â Note: I never get a call > > from the > > > lab saying “hey, this code you continually use does not work > > > anymoreâ€Â 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 April 19, 2010 Report Share Posted April 19, 2010 -25 on the 99213. But don’t count on getting paid for both. It varied widely based on location and payer. Pratt Office Manager Oak Tree Internal Medicine P.C www.prattmd.info From: [mailto: ] On Behalf Of Gordon Sent: Monday, April 19, 2010 7:41 AM To: practiceimprovement1 Subject: coding question when you code a 99213 with a 99396 do you have to have a modifier on either of those codes or do just bill both - also does it matter which one comes first? thanks in advance Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 19, 2010 Report Share Posted April 19, 2010 We get paid for both, usually at 1/2 the 99213 charge, by everyone but Great WEst Health Plan, now. Most have started to pay since UH started. From: [ ] On Behalf Of Pratt [karen.oaktree@...] Sent: Monday, April 19, 2010 10:53 AM To: Subject: RE: coding question -25 on the 99213. But don’t count on getting paid for both. It varied widely based on location and payer. Pratt Office Manager Oak Tree Internal Medicine P.C www.prattmd.info From: [mailto: ] On Behalf Of Gordon Sent: Monday, April 19, 2010 7:41 AM To: practiceimprovement1 Subject: coding question when you code a 99213 with a 99396 do you have to have a modifier on either of those codes or do just bill both - also does it matter which one comes first? thanks in advance Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 20, 2010 Report Share Posted April 20, 2010 I get paid for both as well but most companies pay the lowest one then I have to send the note to get the other part of the visit paid. To: " " < >Sent: Mon, April 19, 2010 5:36:17 PMSubject: RE: coding question We get paid for both, usually at 1/2 the 99213 charge, by everyone but Great WEst Health Plan, now. Most have started to pay since UH started. From: Practiceimprovement 1yahoogroups (DOT) com [Practiceimprovemen t1yahoogroups (DOT) com] On Behalf Of Pratt [karen.oaktree@ comcast.net]Sent: Monday, April 19, 2010 10:53 AMTo: Practiceimprovement 1yahoogroups (DOT) comSubject: RE: [Practiceimprovemen t1] coding question -25 on the 99213. But don’t count on getting paid for both. It varied widely based on location and payer. Pratt Office Manager Oak Tree Internal Medicine P.C www.prattmd. info From: Practiceimprovement 1yahoogroups (DOT) com [mailto:Practiceimp rovement 1yahoogroups (DOT) com] On Behalf Of GordonSent: Monday, April 19, 2010 7:41 AMTo: practiceimprovement 1Subject: [Practiceimprovemen t1] coding question when you code a 99213 with a 99396 do you have to have a modifier on either of those codes or do just bill both - also does it matter which one comes first?thanks in advance Quote Link to comment Share on other sites More sharing options...
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