Re: coding unfairness

[Guest guest]

I'm very curious as to which carrier told you this? They are practicing inappropriate coding. Now in our area the fees for many of the pysch codes are a dew dollars less than submitting a regular office visit based on time and all the rest so we tend not to use them, but none the less, this is their inappropriate error in thinking.

Re: coding unfairness

BUt CAN you do this?when I tried to code 90805 individual pscyhtherapy I was told I cannot use that code as a primary doc

On Mon, Jun 30, 2008 at 6:38 PM, Larry Lindeman <llindemanmac (DOT) com> wrote:

I saw a patient today with a fractured 5th toe. It took about 5 minutes to examine and treat her. If I coded her with an E & M code I probably would code a level 2. However I coded her with an ortho code of 28510 (management of undisplaced fracture of phalanx of the toe). Her insurance will pay me 4x as much if I use an ortho code. It shows how little primary care is valued compared to specialists for comparable work.

Larry Lindeman M.D.

Roscoe Village Family Medicine

2255 W. Roscoe

Chicago, Illinois 60618

www.roscoevillagefa milymedicine. com-- If you are a patient please allow up to 4-8 hours for a reply by email/please note the new email address/e mail may not be entirely secure/ MD ph fax

[Guest guest]

medicaid maine care I never tried agianI can play I just use other codes and go home.

I'm very curious as to which carrier told you this? They are practicing inappropriate coding. Now in our area the fees for many of the pysch codes are a dew dollars less than submitting a regular office visit based on time and all the rest so we tend not to use them, but none the less, this is their inappropriate error in thinking.

Re: coding unfairness

BUt CAN you do this?when I tried to code 90805 individual pscyhtherapy I was told I cannot use that code as a primary doc

On Mon, Jun 30, 2008 at 6:38 PM, Larry Lindeman <llindemanmac (DOT) com> wrote:

I saw a patient today with a fractured 5th toe. It took about 5 minutes to examine and treat her. If I coded her with an E & M code I probably would code a level 2. However I coded her with an ortho code of 28510 (management of undisplaced fracture of phalanx of the toe). Her insurance will pay me 4x as much if I use an ortho code. It shows how little primary care is valued compared to specialists for comparable work.

Larry Lindeman M.D.

Roscoe Village Family Medicine

2255 W. Roscoe

Chicago, Illinois 60618

www.roscoevillagefa milymedicine. com

-- If you are a patient please allow up to 4-8 hours for a reply by email/please note the new email address/e mail may not be entirely secure/

MD ph fax

-- If you are a patient please allow up to 4-8 hours for a reply by email/please note the new email address/e mail may not be entirely secure/ MD

ph fax

[Guest guest]

Do you know of Bert up your way. He is a great guy and very helpful to all us AC users on the board. My goose would have been cooked a number of time without good old Bert's timely tech advice and assists. He is in the Bangor area practicing Peds and also starving on Maineciad or whatever it is you guys have up there. Anyway, if you us AC you two should certainly talk as he is a great friend and resource to us all.

My favorite Maine story was that Bert was called to testify at some family court or child protective services type thing. Now they are seeking his professional opinion and medical expertise in these matters. Obviously one does not go to such a thing empty handed and so one should at least review the record, pull any relavant documents, general prep so right there is some lost time. Anyway this poor good hearted solo doc had to close his practice half or the entire day to go do this as one of his child patients was in the middle of all this.

These bozos had the you know what to pay this poor decent man, a doctor, a whole $12.50 for all his troubles!!! We were all livid about this and for days we were making jokes on the board as to what he should do with the money or the check. Many suggestions were to frame the thing, lots of breakfast at Denny's Jokes including Grand Slams, some to send it back with all sorts of nasty notes, no notes let the silence do the talking, you get the idea here. You Maine docs are certainly in a weird if not bad place there with all this stuff going on... Good luck to ya.

Re: [Practiceimprovemen t1] coding unfairness

BUt CAN you do this?when I tried to code 90805 individual pscyhtherapy I was told I cannot use that code as a primary doc

On Mon, Jun 30, 2008 at 6:38 PM, Larry Lindeman <llindemanmac (DOT) com> wrote:

I saw a patient today with a fractured 5th toe. It took about 5 minutes to examine and treat her. If I coded her with an E & M code I probably would code a level 2. However I coded her with an ortho code of 28510 (management of undisplaced fracture of phalanx of the toe). Her insurance will pay me 4x as much if I use an ortho code. It shows how little primary care is valued compared to specialists for comparable work.

Larry Lindeman M.D.

Roscoe Village Family Medicine

2255 W. Roscoe

Chicago, Illinois 60618

www.roscoevillagefa milymedicine. com

-- If you are a patient please allow up to 4-8 hours for a reply by email/please note the new email address/e mail may not be entirely secure/ MD ph fax -- If you are a patient please allow up to 4-8 hours for a reply by email/please note the new email address/e mail may not be entirely secure/ MD ph fax

[Guest guest]

here in Columbus, this is how it works. If the patient has UHC any kind of psych code, including ADD or insomnia (which really amazes me) as diagnostic codes and any kind of cpt code that connotes a psych diagnosis is automatically kicked out of the UHC system and sent to "the carrier managing the mental health benefits", UBH. Not the United at the beginning of the initials. Now, United Behavioral Health is actually the behavioral health carrier for UHC and a few other small insurance carriers who don't have their own panels but... its really still just UHC. So then they deny my visit because I'm not on their panel. I have had visits for teens involving gyn complaints with a big, huge, labor intensive exam and also included a refill of their adderall, or a diagnosis of insomnia kicked back as not payable because I'm not in their network. So, I have learned to code the return visits as "long term medication follow up nos" and gotten paid. I have considered getting on their panel, but seriously, I don't want to, seriously...

Now, toe fractures, I have definitely been paid for. I also use other somewhat specialist specific codes and get paid great... I'm thinking more derm, or complicated skin closures etc... I also have a contingent of men with warts in extra special locations and these have codes that link the cryo to the extra special location and you get paid like 2-3x for spraying the liquid nitro on a penis or anus as opposed to say, a knee.

The final thing I would like to say, is the company(s) that make it so difficult for primary care physicians to take care of the diagnoses that are present in the majority of their frequent patients (psych overlay, psych primary, axis 2) also have very few psychiatrists on their panel in our area, in fact only 3-4 taking new patients in out city of over 1million people. So folks would wait months (and months and months) to see that very elderly and nearing retirement psychiatrist for their insomnia if in fact he would grant them an appointment at all.

It comes down to people with insurance seeing the primary care physician for their psych complaints in tandem with a decent therapist, or paying out of pocket for the more available psychiatrists here in town.

I did a psych internship and have a live in psychiatry consultant, but I often wonder what other people do, or feel comfortable doing. KrisGas prices getting you down? Search AOL Autos for fuel-efficient used cars.

[Guest guest]

Kris,

Could you share with us what codes you would use for cryo on special body parts that would get 2 to 3x reimbursments?

Thanks.

To: From: mkcl6@...Date: Fri, 4 Jul 2008 06:49:11 -0400Subject: Re: coding unfairness

here in Columbus, this is how it works. If the patient has UHC any kind of psych code, including ADD or insomnia (which really amazes me) as diagnostic codes and any kind of cpt code that connotes a psych diagnosis is automatically kicked out of the UHC system and sent to "the carrier managing the mental health benefits", UBH. Not the United at the beginning of the initials. Now, United Behavioral Health is actually the behavioral health carrier for UHC and a few other small insurance carriers who don't have their own panels but... its really still just UHC. So then they deny my visit because I'm not on their panel. I have had visits for teens involving gyn complaints with a big, huge, labor intensive exam and also included a refill of their adderall, or a diagnosis of insomnia kicked back as not payable because I'm not in their network. So, I have learned to code the return visits as "long term medication follow up nos" and gotten paid. I have considered getting on their panel, but seriously, I don't want to, seriously...

Now, toe fractures, I have definitely been paid for. I also use other somewhat specialist specific codes and get paid great... I'm thinking more derm, or complicated skin closures etc... I also have a contingent of men with warts in extra special locations and these have codes that link the cryo to the extra special location and you get paid like 2-3x for spraying the liquid nitro on a penis or anus as opposed to say, a knee.

The final thing I would like to say, is the company(s) that make it so difficult for primary care physicians to take care of the diagnoses that are present in the majority of their frequent patients (psych overlay, psych primary, axis 2) also have very few psychiatrists on their panel in our area, in fact only 3-4 taking new patients in out city of over 1million people. So folks would wait months (and months and months) to see that very elderly and nearing retirement psychiatrist for their insomnia if in fact he would grant them an appointment at all.

It comes down to people with insurance seeing the primary care physician for their psych complaints in tandem with a decent therapist, or paying out of pocket for the more available psychiatrists here in town.

I did a psych internship and have a live in psychiatry consultant, but I often wonder what other people do, or feel comfortable doing. Kris

Gas prices getting you down? Search AOL Autos for fuel-efficient used cars.

Making the world a better place one message at a time. Check out the i'm Talkathon.

[Guest guest]

I'll check when I get back to my office, but am leaving town today. I will share that there are codes specifically for cryo/destruction of benign lesion (may say wart) on the penis, and another saying the same on the anus. KrisGas prices getting you down? Search AOL Autos for fuel-efficient used cars.

[Guest guest]

, For what it's worth, I was involved in the same case and Bert must be a better expert than I - I got $11.80. It's been a running joke with us for some time now. Jack Forbush, DOOsteopathic Center for Family MedicineHampden, ME 04444www.ocfm.comwww.macdoctors.orgoffice: fax: These bozos had the you know what to pay this poor decent man, a doctor, a whole $12.50 for all his troubles!!! We were all livid about this and for days we were making jokes on the board as to what he should do with the money or the check. Many suggestions were to frame the thing, lots of breakfast at Denny's Jokes including Grand Slams, some to send it back with all sorts of nasty notes, no notes let the silence do the talking, you get the idea here. You Maine docs are certainly in a weird if not bad place there with all this stuff going on... Good luck to ya.

[Guest guest]

Cryosurgery for Common Skin

Conditions

http://www.aafp.org/afp/20040515/2365.html

PRODEDURE -

Cryotherapy, Extensive, Penis lesion(s), Benign CPT54065

PRODEDURE - Cryotherapy,

Simple, Penis lesion(s), Benign

CPT54056

PRODEDURE -

Cryosurgery, Extensive, Anal lesion(s), Benign CPT46924

PRODEDURE - Cryosurgery, Simple, Anal lesion(s), Benign CPT46916

Randall Oates, M.D.

President, SOAPware, Inc.

DOCS-Clinic and Institute, PLC

Personal Mobile

From:

[mailto: ] On Behalf Of mkcl6@...

Sent: Saturday, July 05, 2008 6:58 AM

To:

Subject: Re: coding unfairness

I'll check when I get back to my office, but am leaving town

today. I will share that there are codes specifically for

cryo/destruction of benign lesion (may say wart) on the penis, and another

saying the same on the anus. Kris

[Guest guest]

Jack,

Cool. You know Bert. He is the best! Are you an AC user too or are you flying with something else. He knows so much about computers in general and AC is particular. He is like my guardian angel of computers and EMR's. He wrote a small separate program that works with AC that is an entire document management system called FAP. I like the basic Idea of being able to create my own catagories and having my documents named something much better than the old AC way of 000000001, 0000000002. He says it can stand alone or work with other programs too, but seems to be best suited for the moment for working with AC in particular.

After hearing me talk about IMP's it seems to have peaked his interest. Perhaps you can talk to him a bit as well. Anyway, he is a great guy and knows a lot of good stuff too... He has a good and sometimes twisted sense of humor too...

Re: coding unfairness

,

For what it's worth, I was involved in the same case and Bert must be a better expert than I - I got $11.80. It's been a running joke with us for some time now.

Jack Forbush, DO

Osteopathic Center for Family Medicine

Hampden, ME 04444

www.ocfm.com

www.macdoctors. org

office:

fax:

These bozos had the you know what to pay this poor decent man, a doctor, a whole $12.50 for all his troubles!!! We were all livid about this and for days we were making jokes on the board as to what he should do with the money or the check. Many suggestions were to frame the thing, lots of breakfast at Denny's Jokes including Grand Slams, some to send it back with all sorts of nasty notes, no notes let the silence do the talking, you get the idea here. You Maine docs are certainly in a weird if not bad place there with all this stuff going on... Good luck to ya.