Urology Coding Alert

Question: My office has had an uptick in no-show patients. One of my coders says that he can bill the payer anyway, so we as a practice don’t take the hit financially. Is this true?

Rhode Island Subscriber

Answer: No. If your office has determined it will pursue a billing program for no-shows, and the policy clearly states the terms, you are allowed to bill a fee to the patient, but not the payer.

Here’s why: Payers may only be charged for rendered medical services and/or supplies utilized on the patient. “No-show” appointments mean that no patient showed up and no medical services were performed — therefore, you cannot bill the payer.

Some coders believe you can use CPT^® code 99199 (Unlisted special service, procedure or report) to bill payers for no-shows, but this is not true. The code descriptor’s vagueness has allowed this myth to be perpetuated over the years; offices that have used it often set up an internal charge code with a description of the charge that generates on the patient’s bill.

No one likes to lose patients. However, patients who consistently miss appointments can result in practice financial liability. If the problem reaches a significant percentage of your patient base, it may be in the practice’s best interest to terminate the relationship. As long as the etiquette is clearly outlined in the policy, an office can decide to refuse a patient after a certain number of no-shows.

Potential plan: Some practices opt to send letters to the patient and set a limit for missed visits (such as three no-shows) before dismissing the patient from the practice. If the patient was never seen by the practice, don’t make any more appointments and notify the referring provider (if there is one).