“Good news! We got the results of your coding audit and you missed only three things. Please add a 99214 with a modifier to these three office visits so we can post the charges.” The email went on to list the names and dates of service that I was to address.
I go through this every audit. They always find something to nitpick about every year. One year they tell me to do X. I start doing X. Then the next year they tell me I should never do X, I should be only doing Y. Y was what I had been doing before X. And so on….
I don’t like being wrong. I don’t like making mistakes. I don’t like being told what to do, especially if it is something they are going to change on me next year.
Feeling defensive, I looked back at the visits in question this time.
“No way in hell am I going to add those charges. If coding wants to talk to me about it, I am happy to have a discussion with them but I will not be making these changes to the superbill.”
The office visits in question were yearly physicals. Yearly physicals are considered preventive care by insurance companies and as such, the office visit and routine screening labs are covered at 100% by the insurance company. It is not applied to a deductible. There is no copay, no out of pocket expense.
A “free” visit.
What the coding people wanted me to do was tack on a routine office visit charge in addition to the physical exam visit charge because I addressed something new, like back pain, or made changes to meds for one of their chronic medical problems, like increasing their blood pressure medication.
The problem with this is that particular charge is not a preventive service. It will go to the patient’s deductible. They will get a bill for another $120-140 (or whatever the contracted rate is for their plan) and for most insurances, that means the patient will be paying that entirely themselves out of pocket until their deductible is met. Meanwhile, I get paid for two office visits in the time slotted for the one.
I have been practicing medicine for over ten years. I have known for a long time that it was within my rights to do this but I rarely chose to except for a handful of times in the most extenuating of circumstances.
Just because we can do something does not mean we should do it.
When I have patients skipping specialist referrals and imaging and labs and meds that they really need because of the increasing costs, it bothers me. I need to make money. I do. I have to be able to purchase supplies, pay my staff, and pay the office rent. I need transportation. My kids need clothes, food, and a roof over their heads. The kids will need to go to college and I will need to retire eventually. I make more than enough for this right now, though. I don’t have to double dip.
The thing that puzzles me at this point is why is coding making it an issue now, this year? It isn’t anything new. There is a lot of paranoia in the medical world about what the future holds for physicians financially, especially with all of the crappy changes to Medicare reimbursement, and that may be part of the reason corporate is starting to pressure us further to maximize our bottom line. I do have to make money for them to make money, after all.
And then I start to wonder. Is there something they know that I don’t?
Should I be grabbing everything I can now and retire early… get out of this business entirely before it collapses so I can go do volunteer work somewhere I am really needed?