My Doctor Is Coding The Procedure As An Outpatient Surgical Procedure Which Generates A $250 Copay For Me. I Think This Should Be Coded Differently

Outpatient surgical procedure vs physician office visit with medication administration. There is a big difference in cost to the patient and insurance. Manufacturer lists this as a subcutaneous injection/implantation. It is done with a needle. My doctor is coding as outpatient hospital or surgical center procedure but his office is neither of these. Any advice? I am faced with $250 copay 4x a year. Thx

REPLY

REPORT

Hi Sean,

Looks like quite a predicament going on there between the definition of a surgical procedure and a simple inj. If you could, I would probably encourage you to speak with the front representative at your doctor's office and inform them of the mistake being made before it's too late to have a say in the matter.

Webster's dictionary defines 'surgery' as - "a medical treatment in which a doctor cuts into someone's body in order to repair or remove damaged or diseased parts." However, because this is not the case for your situation, you should be able to dispute the way they interpret it at the office.

Perhaps a second or third opinion from a medical professional will also add validity to your case if necessary.

I hope this helps!

REPLY

Was this helpful? 0

Well a Doctor can most certainly perform outpatient surgery and the ICD Codes ever changing are sometimes limited. This was most certainly not a routine doctors visit when you think about it. I'd call your Insurance carrier and see what they say, perhaps they could provide a better code. Also you can always Google ICD codes although good luck!

REPLY

Was this helpful? 0

My son is having some psychological problem and sifferring from bad mods and anger apathy,aloofness .He does nt see aDoc...

I have been on the same medication for 3 years how do i go about asking my dr to change my medications. How do i explain...

10 REPLIES

My doctor prescribed me to use Osteowin Tablet, i want to know the formulation of this tablets ## For meeting high deman...

2 REPLIES

i started taking a strip of metformi 500 because i want to get pregnant,a couple days after i notice i had a burning sen...

6 REPLIES

Need a pain management doctor in Dallas Fort Worth area that will write pain medicine rx and not just want to do expensi...

2 REPLIES

i have been trying to conceive for 1 year...my doctor prescribed me to take b long f and Susten200 for 3 months. ....but...

1 REPLY

I am taking asomex TM 5 mg. since last two and half months. however this drug have controlled my blood pressure but noe ...

Actually last Saturday I went to hospital so told to the doctor that I am not feeling well and weekness from last 20-25 ...

1 REPLY

Any advice on this situation; the doctor that prescribed my suboxone and the other doctor is a family friend that I went...

5 REPLIES

I have been on 15 milligram oxycodone instant release for almost a year I've got to where there are not working as w...

4 REPLIES