Wiki Cosmetic Consult

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terry4162

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Good Afternoon - Does anyone know if it is appropriate for the physician to bill a cosmetic consult when patient books appointment for possible cosmetic surgery and also bill a consult to the insurance carrier for the functional portion of the surgery that will be billed through the patient's insurance as well as nasal endoscopy?

Thank you for your assistance in this matter.
 
If the provider needs to perform endoscopy in order to perform the cosmetic procedure, then no. Insurance plans do not reimburse for cosmetic procedures. There must be medical necessity. i.e. deviated septum, blepharplasty for drooping eyelids, etc.
 
not sure what you mean by "functional portion"... can you provide more details? (minus patient identifying factors of course)
 
Patient comes in for cosmetic consult for their hump deformity of the external nose. The physician meets with the patient and finds that the patient also has a deviated septum and nasal valve collapse that is a functional problem and not cosmetic which can be billed to the patients insurance. The patient paid for the cosmetic consult, but can the physician also bill the patient's insurance for a new patient visit for the functional conditions.
 
GOTCHA-he can bill an E/M to the ins co IF his documentation meets the requirements for the deviated septum dx. He cannot pull from his documentation on the cosmetic conditions. So you will have to abstract this information from the chart note and see.
 
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