Community Conversation => Transitioning => Topic started by: Amy1988 on April 29, 2014, 04:52:48 PM Return to Full Version
Title: Please explain this medical coding
Post by: Amy1988 on April 29, 2014, 04:52:48 PM
Post by: Amy1988 on April 29, 2014, 04:52:48 PM
A few weeks ago I went to my PC doc for a referral to a urologist for a orchiectomy. I see him this week but today a got a bill from the PC provider with this coding: Offic/outpt visit E&M EST LOW-MOD
Hopefully there are some medical professionals here who can explain what that means and why they charged me $111. Usually I just pay the $25 copay and that's that.
Hopefully there are some medical professionals here who can explain what that means and why they charged me $111. Usually I just pay the $25 copay and that's that.
Title: Re: Please explain this medical coding
Post by: Flan on April 30, 2014, 05:42:09 AM
Post by: Flan on April 30, 2014, 05:42:09 AM
Office/Outpatient visit; Examination and Medication; Established patient (not a walk in/new patient with no history); Low/Moderate Risk Level.
Not sure why insurance didn't cover unless they don't have contract with the provider or the provider screwed up and didn't note referral to insurance which throws a "Primary care provider did not order services" flag.
Not sure why insurance didn't cover unless they don't have contract with the provider or the provider screwed up and didn't note referral to insurance which throws a "Primary care provider did not order services" flag.
Title: Re: Please explain this medical coding
Post by: KarynMcD on April 30, 2014, 10:49:08 AM
Post by: KarynMcD on April 30, 2014, 10:49:08 AM
You might have a limited number of "well" visits per year.
Check your policy or call them and ask.
Check your policy or call them and ask.
Title: Re: Please explain this medical coding
Post by: Amy1988 on April 30, 2014, 04:53:48 PM
Post by: Amy1988 on April 30, 2014, 04:53:48 PM
Quote from: Flan on April 30, 2014, 05:42:09 AM
Office/Outpatient visit; Examination and Medication; Established patient (not a walk in/new patient with no history); Low/Moderate Risk Level.
Not sure why insurance didn't cover unless they don't have contract with the provider or the provider screwed up and didn't note referral to insurance which throws a "Primary care provider did not order services" flag.
Thank you for interpreting that. Now it makes sense. Not sure why they sent me a bill but I'll check into it.
Title: Re: Please explain this medical coding
Post by: Amy1988 on April 30, 2014, 04:55:11 PM
Post by: Amy1988 on April 30, 2014, 04:55:11 PM
Quote from: KarinMcD on April 30, 2014, 10:49:08 AM
You might have a limited number of "well" visits per year.
Check your policy or call them and ask.
Maybe but I've only had two or three visits this year.