# No charge visits



## skrautkramer

Can anyone tell me what the billing and coding guidelines are on "no charge" visits and where to find them? For example, if a doctor sees a patient to discuss a few things and they write "no charge" on the encounter and the office staff tell the patient there is no charge for the day, can the billing staff then still decide to code and bill the office E/M visit? Are there guidelines indicating that this should be billed?


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## nrood

Why wouldn't the provider want to bill for their services? Was it a post op?


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## thomas7331

You won't find coding guidelines for no-charge visits - a no-charge visit isn't coded at all, so there's no right or wrong way to code it.  As far as a coder charging for something that a physician has specifically told the patient is going to be a no-charge, I would highly recommend against this because it is not good customer service to bill the patient once they've been told there won't be a charge and it could negatively impact the physician's relationship with their patients.  In addition, if the physicians own the practice and are your employers, they would likely consider this to be insubordination.  

But that said, if you see that physicians are giving away free visits that they should be charging for, you should discuss these concerns with your manager or the practice owners.  There are some potential compliance implications to giving away services for free, especially if it involves Medicare patients.  And of course, the revenue loss to the practice involved in treating patients without charge needs to be considered as well.  It's best for a practice to have a written policy for when and how no-charge visits will be offered.


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## thranowski

This is incredibly risky. If insurances find out you are giving away services for free, they can come back and recoup money from every other similar service they paid you for. Their logic is: why are you charging these patients nothing, but you're charging BCBS this?

I know of providers in my area that this happened to. One was a cardiologist who waived copays for certain patients. One private insurance took back all copays from every other patient he saw for the same services.

So if your doctor is seeing a patient for what would have been a 99213 and doesn't bill the insurance or waives the copay, but will bill 99213 for the same exact service to another patient or insurance, you need to be extremely careful.


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