求问美国专科看诊bill

m
mojolady
楼主 (北美华人网)
一个印度医生,专科看诊费用 10分钟的zoom meeting,charge了45~60min的code:99204,这是什么情况?
因为马上要到这个医生那里做胃镜,感觉这个人做事不太合规矩,有点担心。。。
o
oqo
一个印度医生,专科看诊费用 10分钟的zoom meeting,charge了45~60min的code:99204,这是什么情况?
因为马上要到这个医生那里做胃镜,感觉这个人做事不太合规矩,有点担心。。。
mojolady 发表于 2022-06-27 14:10

换医生
b
bye2020
这个可以跟保险公司投诉upcoding
m
mojolady
这个可以跟保险公司投诉upcoding
bye2020 发表于 2022-06-27 14:22

刚刚查了一下,这个医生在after visit summary里写: The total time spent preparing to see the patient, obtaining or reviewing history obtained, performing exam and evaluation, counseling and education of patient/family /caregiver, ordering medications, tests, procedures, referring and communicating with other healthcare providers , documenting in the EHR, independent interpretation of results and care coordination / medical discussion was 45 minutes.
明显,他把他meeting之外的时间也算在我的meeting里了,这个合理吗?
s
steve888
刚刚查了一下,这个医生在after visit summary里写: The total time spent preparing to see the patient, obtaining or reviewing history obtained, performing exam and evaluation, counseling and education of patient/family /caregiver, ordering medications, tests, procedures, referring and communicating with other healthcare providers , documenting in the EHR, independent interpretation of results and care coordination / medical discussion was 45 minutes.
明显,他把他meeting之外的时间也算在我的meeting里了,这个合理吗?
mojolady 发表于 2022-06-27 14:27

合理。规矩是这么算的。
m
mojolady
合理。规矩是这么算的。
steve888 发表于 2022-06-27 14:31

可是Bill code里明确说明45分钟是face-to-face的,你看下面👇
CPT 99204 Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family. Billing Instructions: Bill 1 unit per visit.

g
gokgs
都这样吧? 一般都是五六分钟搞定。
s
summerfallisme
回复 1楼mojolady的帖子
我不论看家庭医生还是专科医生都是charge的code比实际花的时间多,或者诊疗没有到达code描述的复杂程度。反正付copay就行了,就没有管。他们跟保险公司要钱多。
m
mellamoperro
99204以前会有一个时间上的要求,去年开始的coding改革后就不需要了。 满足99204,更取决于医生给你的诊断有几个,有没有开药,有没有开检查,有没有和你review之前的记录。 以上几点满足几个就可以了。程序上完全合规。
s
steve888
可是Bill code里明确说明45分钟是face-to-face的,你看下面👇
CPT 99204 Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family. Billing Instructions: Bill 1 unit per visit.


mojolady 发表于 2022-06-27 14:35

你这个哪里找的。手册上没有face to face这一说。只说当天花了45-49分钟就行。另外不用时间选code也行,新病人或者中等严重的都可以用这个。
小风车
病人的病历都要事先review,不然和病人谈话的时候自己都不知道病人情况能是好医生么?看完以后还要写病历有的时候还要和其他科室的医生讨论病人情况,看化验报告,也是要花很多时间。
m
mellamoperro
回复 6楼mojolady的帖子
改革之后时间并不是主要的bill因素。
m
mojolady
你这个哪里找的。手册上没有face to face这一说。只说当天花了45-49分钟就行。另外不用时间选code也行,新病人或者中等严重的都可以用这个。
steve888 发表于 2022-06-27 14:58

你的手册是指那个?求分享。我是看网上这个link: https://medicarepaymentandreimbursement.com/2010/10/office-visit-cpt-code-does-require.html。似乎是2010年的,所以新code有update?
m
mojolady
回复 6楼mojolady的帖子
改革之后时间并不是主要的bill因素。
mellamoperro 发表于 2022-06-27 15:00

这样啊,了解了,谢谢分享。
b
bye2020
回复 6楼mojolady的帖子
改革之后时间并不是主要的bill因素。
mellamoperro 发表于 2022-06-27 15:00

请问zoom和ftof一样bill吗?
2
2wawa
这个很正常吧。我不喜欢医生事先不看chart,一边看一边问一些chart里写的问题,有时候很stupid
w
wielkacytryna
回复 6楼mojolady的帖子
改革之后时间并不是主要的bill因素。
mellamoperro 发表于 2022-06-27 15:00

怪不得美国medical coding也是个行业 这里面各种代号真复杂啊
c
citan007
mark
m
momclub17
可是Bill code里明确说明45分钟是face-to-face的,你看下面👇
CPT 99204 Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family. Billing Instructions: Bill 1 unit per visit.


mojolady 发表于 2022-06-27 14:35

99204现在可以是telehealth了。