Hello wiser-than-I ones,
A mom emailed saying that her insurance company told her on the phone that
they would reimburse her for my consult if I used the codes 99201-99203.
Now I am always undervaluing, using the 75 minute home visit code for a
visit, whether 90 minutes or 3 1/2 hours (a consult on this past Saturday, with
a 5 day old losing weight, mom with almost no milk, refusing to use
anything but the starter SNS the hospital had given her, until husband got
regular SNS against my suggestions, which wasn't functioning properly, followed
by the mom alternating breaking down, yelling at me, yelling at the husband,
yelling to her sister, and the husband then crying. This is in NO way a
visit of "low or medium" complexity!".. ) But the 99345 codes are being
rejected, even with the severe undervaluing. So, now the insurance company says
it will reimburse with the 99203, which is a "30 minute office visit of low
complexity." My question is, if this is ethical to use a code that does
not describe our consult, so the mom will get reimbursed ( if indeed they do
in reality.) Now, I can understand that the "low complexity of medical
decision making" might actually be true, since I am not making "medical"
decisions at all.
What are other people thinking and doing in this mess of misunderstanding?
Peace,
Judy
Judy LeVan Fram, PT, IBCLC, LLLL
Brooklyn, NY, USA
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