Wiki Billing wart removal with an E/M instead?

[KarinRaus]

One of my providers asked this question, and it gets me wondering myself. If we see a patient for a wart removal, bill out the 17110, the wRVU's on that are lower than they are for a 99213. So his question was, would it be inappropriate to bill for the office visit instead, particularly since the 17110 always goes to the patient's surgical deductible, so they have a much higher out of pocket? My question on that would be, how would an auditor look upon that? We're not trying to get both, just one or the other, and the OV seems to be of greater benefit for both the doc and the patient than the procedure, in this case. Thoughts?

 

[thomas7331]

No, a wart removal is not an E&M service. An auditor would cite it as an error and, if acting on behalf of a payer, would recover the overpayment from your practice. You can only bill what is supported by the documentation.

It may be well-intentioned to want to help out the patient with their out of pocket costs, but that is actually considered a non-compliant and potentially fraudulent activity. The patient's cost share requirements are between them and their insurance plan and your provider should not attempt to circumvent that with incorrect coding - it can be seen by payers as an illegal 'inducement' to the patient - a financial favor improperly given to the patient to gain their favor.