My plastic surgeons do ER rotations, and we are running into a situation where Medicare patients are requesting plastic surgeons to perform repairs (especially on the face) which can be done by the ER physician.
One of my doctors (who is par with Medicare) explained to a patient that his services would be considered cosmetic and would not be covered by Medicare, and had the patient sign an ABN after she agreed with him. But the CPT codes are those for complex repair (e.g., 13132), which are payable by Medicare, so the ABN doesn't really apply. My doctor is adamant about directly billing the patient, and I am looking for some documentation to show him either way (possible or not possible). I was also thinking if we used DX code V50.9 for elective surgery, which is technically correct for this patient, then even if submitted to Medicare, the claim would deny.
The doctor has gotten signed ABNs before, but when the patient gets the bill, the first thing they do is call Medicare and complain, which results in a call to us stating that we must bill Medicare and can't bill the patient over the fee schedule, even though the consult report clearly states the patient requested a plastic surgeon to minimize scarring and we have a signed ABN.
I'm uncomfortable with this whole idea, but I understand my doctor's point of view. And I think if a Medicare patient requests a plastic surgeon when the ER doctor is comfortable with providing the service, that patient ought to pay for the requested services out of pocket.
Any advice would be appreciated. And links to any documentation I can show to my doc would be great.
One of my doctors (who is par with Medicare) explained to a patient that his services would be considered cosmetic and would not be covered by Medicare, and had the patient sign an ABN after she agreed with him. But the CPT codes are those for complex repair (e.g., 13132), which are payable by Medicare, so the ABN doesn't really apply. My doctor is adamant about directly billing the patient, and I am looking for some documentation to show him either way (possible or not possible). I was also thinking if we used DX code V50.9 for elective surgery, which is technically correct for this patient, then even if submitted to Medicare, the claim would deny.
The doctor has gotten signed ABNs before, but when the patient gets the bill, the first thing they do is call Medicare and complain, which results in a call to us stating that we must bill Medicare and can't bill the patient over the fee schedule, even though the consult report clearly states the patient requested a plastic surgeon to minimize scarring and we have a signed ABN.
I'm uncomfortable with this whole idea, but I understand my doctor's point of view. And I think if a Medicare patient requests a plastic surgeon when the ER doctor is comfortable with providing the service, that patient ought to pay for the requested services out of pocket.
Any advice would be appreciated. And links to any documentation I can show to my doc would be great.