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。。。

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

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？

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。

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.

都这样吧？ 一般都是五六分钟搞定。

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。

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。

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。